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DocuSign Envelope ID: 7796CD94- 342E- 40D0- B7C3- A2B604F926B4 <br />f <br />ORANGE COUNTY <br />l4A'- 6A -5(a ) <br />Name of Contractor, Vendor or Bidder. <br />Department of Solid Waste Management <br />As of the date listed below, the contractor. vendor or bidder listed above, and all subcontractors <br />uliliized by the contractor, vendor or bidder listed above, is not listed on tite Final Divestment list <br />created by the State Treasurer pursuant to N.C.G.S. 143 -6A -4. <br />The undersigned licreby 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 fry persons sighing this ftwnt: <br />N.C.G.S. 143C-6A-5(a) requires this certification for bids or contracts with [lie State of North <br />Carolina, a North Carolina local government, or any other political subdivision of the state of North <br />Carolina. The certification is required at the following tinges: <br />❑ When a bid is submitted <br />C3 When a contract is entered into (if the certification was not already made when the vendor <br />made its bid) <br />c When a contract is renewed or assigned <br />N.C.G.S. 1430- 6A -5(b) mquir+es that contractors with the State, a North Carolina local government, <br />or any other political subdivision of the State of Nardi Carolina must not utilize any subcontractor <br />found on the State Treasurer's Final Divestment List. The State Treasurer's Final Divestment List <br />can be found on the State Treasun=r's website at the address www.netreasurer.comilran and will be <br />updated every 180 days. <br />'' * '"Contractor, Vendor or Bidder Return This Form With All Other Required Documentation " <br />24 <br />RFP Na. 5427 <br />