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DocuSign Envelope ID: BF09D2E9-7297-4B22-8360-A1E6C073ECAF <br /> ATTACHMENT E- IRAN DIVESTMENT ACT CERTIFICATION <br /> Required By N.C.G.S. <br /> 143C-6A-5(a) <br /> Name of Contractor, Vendor or Bidder. <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 List <br /> created by the State Treasurer pursuant to N.C.G.S. 143-bA-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 Date <br /> Printed Name Title <br /> Notes to persons signing this farm: <br /> N.C.G.S. 143C-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 North <br /> 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. 143C-6A-5(b)requires that contractors with the State,a North Carolina local government, <br /> or any other political subdivision of the State of North Carolina must not utilize any subcontractor <br /> found on the State Treas tire r`s Final Divestment List. The State Treasurer's Final Divestment List <br /> can be found on the State Treasurer's website at the address www.nctreasuner.comJIran and will be <br /> updated every I80 days. <br /> *****Contractor,Vendor or Bidder Return This Forrn With All Other Required Documentation"'" <br /> RFP No.5259 <br />