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DocuSign Envelope ID: D12D805C-2FE9-453A-BC1C-9C0147D6BB12 <br /> Chapter 105 of the General Statutes on its sales delivered to North Carolina when the sales met one or <br /> more of the conditions of G.S. 105-164.8(b); and <br /> (13) [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.land-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 $14.25 per/hr.) Check here Z 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 /> CNC/ACCess,Inc. dba Rescare Homecare <br /> oc6 uSig`rre` y: <br /> C ntr i"BCIOr S N�ilk <br /> �t,V1M�t,V�'bbt, 9/17/2018 <br /> sPG2 <br /> Signature of Contractor's Authorized Agent Date <br /> Sherry Permberton vice President sales & Marketing <br /> r nee a lUSf Contractor's Authorized Agent Title <br /> Contract & Credentialing Assistan <br /> Signature of Witness Title <br /> Heather Wilson 9/17/2018 <br /> Printed Name of Fitness 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 /> revised May 30,2018 <br />