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DocuSign Envelope ID: D1041CA6-DBD4-42BE-8B32-7C592BF2BA15 <br /> Enterprise Asset Management Software RFP #5220 ORANGE COUN ly <br /> )Rt I I 'ARO( <br /> p a fa <br /> ^ tuut <br /> RA NI ACT RT 1 F 1 CAT N <br /> Fly()I. Y sk C S <br /> 143C-6A-5(a) <br /> Name of Contractor, Vendor or Bidder: TMA Systems,L.L.C. <br /> As of the date listed below, the contractor, vendor or bidder listed above, and all subcontractors <br /> utilized by the contractor, vendor or bidder listed above, is not listed on the Final Divestment List <br /> created by the State Treasurer pursuant to N.C.G.S. 143-6A-4. <br /> The undersigned hereby certifies that he or she is authorized by the contractor, vendor or bidder <br /> listed above to make the foregoing statement. <br /> May 9,2016 <br /> Signature Date <br /> Dustin Taylor President <br /> Printed Name Title <br /> Notes to persons signing this form: <br /> N.C.G.S. 143C-6A-5(a)requires this certification for bids or contracts with the State of North <br /> Carolina, a North Carolina local government, or any other political subdivision of the State of North <br /> Carolina. The certification is required at the following times: <br /> When a bid is submitted <br /> ;Sf When a contract is entered into(if the certification was not already made when the vendor <br /> made its bid) <br /> 171 When a contract is renewed or assigned <br /> N.C.G.S. 143C-6A-5(b)requires that contractors with the State, a North Carolina local government, <br /> or any other political subdivision of the State of North Carolina must not utilize any subcontractor <br /> found on the State Treasurer's Final Divestment List. The State Treasurer's Final Divestment List <br /> can be found on the State Treasurer's website at the address www,netreasurencom/han and will be <br /> updated every 180 days. <br /> *****Contractor,Vendor or Bidder—Return This Form With All Other Required Documentation***** <br /> Orange County,200 S.Cameron Street,Hillsborough,North Carolina 27278 Page 40 <br />