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DocuSign Envelope ID: E51E535C-r71e-44A8-80o0eEAe7rrA0A81 <br /> more of the conditions of G.S. 105-164.8(b) and . <br /> ![check one of the following boxes] / <br /> (b) <br /> I I Neither the Contractor nor any of its affiliates has incorporated or reincorporated in a "tax haven <br /> set 31, 2001;or <br /> F Tbu <br /> country" ctor or one of its affiliates has incorporated or in a "tax haven <br /> as set forth in G.S. 143-59.1kJC2) after December 31, 2001 but the United States is not the <br /> principal market for the public trading of the stock of the corporation incorporated in the tax <br /> haven country. <br /> (3) Pursuant to G.S. 1.43-59.2/bA, the undersigned hereby certifies that none of the Contractor's officers, directors, <br /> or owners (if the Contractor is an unincorporated business entity) has been convicted of any violation of Chapter <br /> 78A of the General Statutes or the Securities Act of 1933 or the Securities Exchange Act of 1934 within 10 years <br /> immediately prior to the date of the bid solicitation. <br /> (4) The undersigned hereby certifies further that: <br /> (a) He or she is a duly authorized representative of the Contractor named below; <br /> (b) He or she is authorized to make, and does hereby make, the foregoing certifications on behalf of the <br /> Contractor; and <br /> (c) He or she understands that any person who knowingly submits a false certification in response to the <br /> requirements of OS. \43'59.luod -59.2 shall he guilty of a Class I felony. <br /> (5) Pursuant to the Orange County Living Wage Contractor's Policy: <br /> (a) The undersigned certifies that the Contractor pays the employees who perform services under this contract a <br /> living wage (in Orange County currently $13.75 pur/br.) Check here El if contractor pays employees <br /> performing under this contract a living wage. If Contractor does not pay employees a living wage,what is the <br /> wage that employees peiforming services under this contract paid <br /> personalized Patient Home Assistance <br /> ` <br /> (L7HYiqoYlly*g'Namoc <br /> 7/21/2017 <br /> Signature"""��Y�Obtcan1or`u Authorized Agent Date <br /> Dorothea Farrington Agency director <br /> rov7artilie of Cot tractor's Title <br /> Attorney <br /> carmilla Farrington 7/21/2017 <br /> Printed Name of Witness Date <br /> The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and date <br /> this document immediately thereafter. <br /> Contractor Certifications Required by North Carolina Law Page 2 of 3 <br />