2019-704-E DSS - KAH Care LLC dba Right at Home in home aide services

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DocuSign Envelope ID:5330770B-8F93-4746-9A9E-98B8628F995F ATTACHMENT M State and Local Certifications Contractor Certifications Required by North Carolina Law Orange County Department of Social Services and Department on Aging Instructions:The person who signs this document should read the text of the statutes and Executive Order listed below and consult with counsel and other knowledgeable persons before signing.The text of each North Carolina General Statutes and of the Executive Order can be found online at: • Article 2 of Chapter 64: http:llwww.nc&a.state.nc.us/En acted Legislation/Statutes/PDFByArticle/Chapter 64/Article 2.ndf • G.S. 133-32: http://www.ncga.state.nc.us/gascrints/statutes/statuteiookup.pi?statute=133-32 ■ Executive Order No.24(Perdue,Gov.,Oct. 1,2009): http://www.ethicscommission.nc.gov/library/Sdfs/Laws/E024.pdf ■ G.S. 105-164.8(b): htty://www.ncP-a.state.nc.us/EnactedLegis]ation/Statutes/PDF/BySection/Chapter_Id5/GS_1o5-1,648.pdf ■ G.S. 143-48.5: httn://www.ncga.state.nc.us/Enacted Legis[at ion/Statutes/HTMUBySection/Chapter 143/GS_143-48.5.html • G.S. 143-59.1: http://www.ncga.state.nc.us/EnactedLegisIatior/Statutes/PDFBySection/Chapter_143/GS_143-59.l.pdf ■ G.S. 143-59.2: http:llwww.ncga.state.nc.us/EnactedLegisIationlStatutes/PDFJBySection/Chapter_143/GS_143-59.2.pdf • G.S. 143-133.3: httn://www.ncga.state.ne.us/EnactcdLe&is[atior/Statutes/HTMLJ]BySection/Chapter_143/GS_143-133.3.htirtl • G.S. 143B-139.6C: htip://www.ncea.state.nc.uslEnactedLegislation/Statutes/PDFMySection/Chapter_143B/GS_i43B-139W.pdf • The text of Orange County Living Wage Contractor Policy which is attached to this document. Certifications (1) Pursuant to G.S. 133-32 and Executive Order No.24 ❑Neither the Contractor nor any of its affiliates (Perdue, Gov., Oct. 1, 2009), the undersigned hereby has incorporated or reincorporated in a "tax certifies that the Contractor named below is in haven country" as set forth in G.S. 143- compliance with,and has not violated,the provisions of 59.1(c)(2)after December 31,2001; or either said statute or Executive Order. (2) Pursuant to G.S. 143-48.5 and G.S. 143-133.3, the undersigned hereby certifies that the Contractor named ® The Contractor or one of its affiliates has below, and the Contractor's subcontractors, complies incorporated or reincorporated in a "tax haven with the requirements of Article 2 of Chapter 64 of the country" as set forth in G.S. 143-59.1(c)(2) NC General Statutes, including the requirement for after December 31, 2001 but the United States each employer with more than 25 employees in North is not the principal market for the public trading Carolina to verify the work authorization of its of the stock of the corporation incorporated in employees through the federal E-Verify system." E- the tax haven country. Verify System Link: www.uscis.gov (4) Pursuant to G.S. 143-59.2(b), the undersigned hereby certifies that none of the Contractor's officers, Local government is specifically exempt from Article 2 directors, or owners (if the Contractor is an of Chapter 64 of the North Carolina General unincorporated business entity) has been convicted of Statutes. However, local government is subject to and any violation of Chapter 78A of the General Statutes or must comply with North Carolina General Statute the Securities Act of 1933 or the Securities Exchange 153A-99.1,which states in part as follows: Act of 1934 within 10 years immediately prior to the Counties Must Use E-Verify-Each county shall date of the bid solicitation. register and participate in E-Verify to verify the work (5) Pursuant to G.S. 1438-139.6C, the undersigned authorization of new employees hired to work in the hereby certifies that the Contractor will not use a United States. former employee, as defined by G.S. 14313- (3) Pursuant to G.S. 143-59.1(b), the undersigned hereby 139.6C(d)(2), of the North Carolina Department of certifies that the Contractor named below is not an Health and Human Services in the administration of a "ineligible Contractor" as set forth in G.S. 143-59.1(a) contract with the Department in violation of G.S. because: 14313-139.6C and that a violation of that statute shall void the Agreement. (a) Neither the Contractor nor any of its affiliates has (6) The undersigned hereby certifies further that: refused to collect the use tax levied under Article 5 of Chapter 105 of the General Statutes on its sales delivered to North Carolina when the sales met (a) He or she is a duly authorized representative of the Contractor named below; one or more of the conditions of G.S. 105- 1 d4.${b}; and (b) He or she is authorized to make, and does hereby (b) [check one of the following boxes] make, the foregoing certifications on behalf of the Contractor;and Contractor Certifications Required by North Carolina Law(Rev.8/2016) Pam I of 3