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DocuSign Envelope ID: B75E8AA0-ADE3-4E77-B32C-2134D9CAA555 <br /> Do not submit with bid Do nos submit with bid Do not submit with bid Do not submit with bid <br /> State of North Carolina - AFFIDAVIT C - Portion of the Work to be <br /> Performed by HUB Certified/Minority Businesses <br /> County of Durham <br /> (Note this form Is to be submitted only by the apparent lowest responsible, responsive bidder.) <br /> if the portion of the work to be executed by HUB certified/minority businesses as defined in GS143- <br /> 128.2(g)and 128.4(a),(b),(e) is equal to or greater than 10%of the bidders total contract price, then the <br /> bidder must complete this affidavit. <br /> This affidavit shall be provided by the apparent lowest responsible, responsive bidder within 72 hours <br /> after notification of being low bidder. <br /> Affidavit of C.T.Wilson Construction Company, Inc. I do hereby certify that on the <br /> (Name of Bidder) <br /> Orange County Emergency Eme[gency Office U fit Whiffed Building <br /> Project 1D# 19-039 (Project Name) Amountof Bid $ 241,651 <br /> 1 will expend a minimum of 4.4 % of the total dollar amount of the contract with minority business <br /> enterprises. Minority businesses will be employed as construction subcontractors, vendors, suppliers <br /> or providers of professional services. Such work will be subcontracted to the follovving finrs listed <br /> below. Attach additional sheets if re uired <br /> Name and Phone plumber *Minority "HUB Work Dollar Value <br /> Category Certified Description <br /> YIN <br /> Waspco F Y Drywall 10,640 <br /> 'Minority categories:Black,African American(B), Hispanic(H),Asian American(A)American Indian(t), <br /> Female(F)Socially and Economically Disadvantaged (D) <br /> HUB Certification with the state HUB office required to be counted toward state participatlon goals. <br /> Pursuant to GS143-128.2(d), the undersigned will enter into a formal agreement with Minority Firms for <br /> work listed in this schedule conditional upon execution of a contract with the Owner. Failure to fulfill <br /> this commitment may constitute a breach of the contract. <br /> The undersigned hereby certifies that he or she has read the terms of this commitment and is <br /> authorized to bind the bidder to the commitment herein set forth. <br /> g4tei,441 2020 Name of Authorized Officer: Charles T.Wilson III <br /> A <br /> A,�P Signature: � �,- <br /> z rt, Not y Public <br /> Cozz Wake Title: President <br /> CourWAL <br /> My °n'm ExR State of [Dyol►(A County of wkau <br /> s ,y oil- 2022 <br /> .� Subscribed and sworn to before me this_7}1_ day of t4pR 2010 <br /> i Q <br /> 9T R �I O ��` Notary Public Elto, li W►'ttlr� <br /> 'A �ti My commission expires 011141 uy- <br /> MBForms 2002-Reviscd July 2010 <br />