Orange County NC Website
Browse       Search
DocuSign Envelope ID: 6E30952E- 74C9- 4C59- 8050- B1AE415FDFED <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: 1-�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 <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 <br />Date <br />A, E V6- <br />Printed Name Title <br />Notes to persons signing this form: <br />N.C.G.S. 1430- 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. 1430- 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 />and will be updated every 180 days. <br />* * ** *Contractor, Vendor or Bidder -- Return This Form With All Other Required Documentation * * ` <br />