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DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C <br />more of the conditions of G.S. 105- 164.8(b); and <br />(b) [check one of the following boxes] <br />❑ Neither the Contractor nor any of its affiliates has incorporated or reincorporated in a "tax haven <br />country" as set forth in G.S. 143- 59.1(c) (2) after December 31, 2001; or <br />❑ The Contractor or one of its affiliates has incorporated or reincorporated in a "tax haven country" <br />as set forth in G.S. 143- 59.1(c)(2) 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. 143- 59.2(b), 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 G.S. 143 -59.1 and -59.2 shall be 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 per /hr.) Check here ❑ 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 performing services under this contract paid <br />Inter -Faith Council for Social Service <br />DocuSigned by: le <br />@317305AEFF04A9 . <br />signature or contractor's Authorized Agent <br />7ackie 7enks <br />DocuSigned by: <br />s� �y�& <br />93B45EA087'D426_. <br />�irgnaturc of witness <br />Stephani Kilpatrick <br />Printed Name of Witness <br />or's Authorized Agent <br />2/13/2018 <br />Date <br />Executive Director <br />Title <br />Residential Services Director <br />Title <br />2/14/2018 <br />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 />