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State CCMVRQWRW&r 00036254, Amendment Number 2 / Page 16 of 17 <br />Contractor Certifications Required by North Carolina Law <br />Instructions: The person who signs this document should read the test of the statutes and Executive Order listed below and consult <br />with counsel and other knowledgeable persons before signing. The text of each North Carolina General Statutes and of the Executive <br />Order can be found online at: <br />• Article 2 of Chapter 64: lntp•� tvww.nega.state.nc.u,, r. nactedLegislation'StututcslPDl' 13yArticleiChapter _64/Anicle_2.pdf <br />• G.S. 133 -32: hnp: N «ww.ncga.state.ne.us'g;ucripts' statutes /statutcloakup.pl'Istatutu 133 -32 <br />• Executive Order No. 24 (Perdue, Gov., Oct. 1, 2009): http:: .'wnw.cthicsconunission.ne,gov/ library/pol'sll,uws /i 024.pd1 <br />• G.S. 105- 164.8(b): liltp:!/ w%tw'.ncga.state.nc.us /Cnuciedl e gislation /Slatules/I'DI -'/BySect ion ,Chapter_105 /GS_105.16.1.8.pdf <br />• G.S. 143 -48.5: hap:% hctvw. ncgastate. nc. uslGnactcdLegislution.' StatuteslllTML /l3ySection!Chapter 143/GS143.48.3.111ml <br />• G.S. 143 -59.1: http: /Avww.ncga. state .ne.u..'1- nactedLegislat ion % Statutes /l'Dl' /ByScction!Chapter 143/GS 143- 59.I.pdf <br />• G.S. 143 -59.2: http:// www. ncga. state.ne.us41?nactedLegislation " Statutes /PDI)P /BySection /Chapter_ tai /GS 143- 59.2.pdr <br />• <br />G.S. 143-133.3: http:/ iwwv v. ncga .state.nc.uA- nucteJLrgislation: Statutes'1 rrNl L/ l3ySection JChupter_143iGS_143- 133.3.html <br />• G.S. 143B- 139.6C: htip: //%v►»v.ncga. state. ne. us /Enactedt.egislalion/ Statutes/ l' DI"/ IlySLeliutdCllaptcr ..143B/CjS_143B- i39.6C.pdt* <br />(1) <br />(2) <br />(3) <br />Certifications <br />Pursuant to G.S. 133 -32 and Executive Order No. 24 <br />(Perdue, Gov., Oct. 1, 2009), the undersigned hereby <br />certifies that the Contractor named below is in <br />compliance with, and has not violated, the provisions of <br />either said statute or Executive Order. (4) p <br />Pursuant to G.S. 143 -48.5 and G.S. 143- 133.3, the <br />undersigned hereby certifies that the Contractor named <br />below, and the Contractor's subcontractors, complies <br />with the requirements of Article 2 of Chapter 64 of the <br />NC General Statutes, including the requirement for <br />each employer with more than 25 employees in North <br />Carolina to verify the work authorization of its <br />employees through the federal E- Verify system." E- <br />Vcrifv Systcm Link: wzv ,Nv.uscis.gov <br />Pursuant to G.S. 143- 59.1(b), the undersigned hereby <br />certifies that the Contractor named below is not an <br />"ineligible Contractor" as set forth in G.S. 143- 59.1(a) <br />because: <br />(a) Neither the Contractor nor any of its affiliates has <br />refused to collect the use tax levied under Article 5 <br />of Chapter 105 of the General Statutes on its sales <br />delivered to North Carolina when the sales met <br />one or more of the conditions of G.S. 105 - <br />164.8(b); and <br />(b) [check one of the following boxes] <br />® Neither the Contractor nor any of its affiliates <br />has incorporated or reincorporated in a "tax <br />haven country" as set forth in G.S. 143 - <br />59.1(c)(2) after December 31, 2001; or <br />❑ The Contractor or one of its affiliates has <br />incorporated or reincorporated in a "tax haven <br />country" as set forth in G.S. 143- 59.1(c)(2) <br />(5) <br />(6) <br />after December 31, 2001 but the United States <br />is not the principal market for tite public trading <br />of the stock of the corporation incorporated in <br />the tax haven country. <br />irsuant to G.S. 143- 59.2(b), the undersigned hereby <br />certifies that none of the Contractor's officers, <br />directors, or owners (if the Contractor is an <br />unincorporated business entity) has been convicted of <br />any violation of Chapter 78A of the General Statutes or <br />the Securities Act of 1933 or the Securities Exchange <br />Act of 1934 within 10 years immediately prior to the <br />date of the bid solicitation. <br />Pursuant to G.S. 14313- 139.6C, the undersigned <br />hereby certifies that the Contractor will not use a <br />former employee, as defined by G.S. 14313- <br />139.6C(d)(2), of the North Carolina Department of <br />Health and I luman Services in the administration of a <br />contract with the Department in violation of G.S. <br />1436- 139.6C and that a violation of that statute shall <br />void the Agreement. <br />The undersigned hereby certifies further that: <br />(a) I le or she is a duly authorized representative of the <br />Contractor named below; <br />(b) He or she is authorized to snake, and does hereby <br />snake, the foregoing certifications on behalf of the <br />Contractor; and <br />(c) He or site understands that any person who <br />knowingly submits a false certification in response <br />to the requirements of G.S. 143- 59.1and -59.2 <br />shall be guilty of a Class I felony. <br />contractor's Name: Orange County Department of Social Services <br />Contractor's <br />Authorized Agent: Signature Date l0 /l2 /2017 <br />1'nntcd Name -Nancy Coston title Director <br />witness: Signature Date 10/12/2017 <br />printed Nome Serena McPherson <br />ride Administrative Services Supervisor <br />Conlrmior C enilicatims Required by North Carolina Law Wev RC016) Pace I of <br />