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23 <br /> *****Contractor,Vendor or Bidder—Return This Form With All Other Required Documentation***** <br /> IRAN DIVESTMENT ACT CERTIFICATION REQUIRED BY N.C.G.S. <br /> 143C-6A-5(a) <br /> Name of Contractor,Vendor or Bidder: <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 <br /> List 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 /> Signature Date <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 <br /> North Carolina. The certification is required at the following times: <br /> ❑When a bid is submitted <br /> ❑When a contract is entered into(if the certification was not already made when the vendor <br /> made its bid) <br /> ❑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 <br /> government, or any other political subdivision of the State of North Carolina must not utilize <br /> any subcontractor found on the State Treasurer's Final Divestment List. The State Treasurer's <br /> Final Divestment List can be found on the State Treasurer's website at the address <br /> www.nctreasurer.com/Iran and will be updated every 180 days. <br /> *****Contractor,Vendor or Bidder—Return This Form With All Other Required Documentation***** <br />