2020-896-E Housing - NC Dept of Health and Human Services CARES Act funding

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DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B Contract Number 00041659/Page 22 of 22 State Certifications Contractor Certifications Required by North Carolina Law Instructions The person who signs this document should read the text of the statutes fisted below and consult with counsel and other knowledgeable persons before signing, The text of cacti North Carolina General Statutes can be found online at: • Article 2 of Chapter 64: h :/ e s to nc► Lin c edLe isl tt t/S u esl 13 Ar icle/Cha er b4/Article 2 df • G,S, 105-164,8(b); h tr r s e rc sjElig9tedLegislation e' PDF B Sec io C r 105 GS I05-16 8 )df •" G,S. 143-48.5 ft ... p h. ' 11www nog aatot.c nc,itslEnac isle for S tr esl 1' 13 Section Ch a 1 3 GS 1 3= 8.5 htinl ' 03, I43-59.1; hit : s ten t s e Isl on St h to IPDr B Sac iorrlClr et 1 3 GS 143-59,1,pdf G.S. 143-59.2; l 3 GS 143-59 2 G.S. 147-33.95(g): c s e nc t sl ctedLe •s r S to II B ion Ci a t t GS 1 -33.95 €rhrfi Certifications (1) Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g),the undersigned hereby certifies that the Contractor named below,and the Conhraetor's subcontractors, complies with the t'eclutretnents of Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer with ;pore than 25 employees in North Carolina to verify the work authorization of its employees through the federal 13-Varify system."E-Verify System Link: www.uscis.rcov (2) Pursuant to G.S. 143-59,1(b), the undersigned hereby certifies that the Contractor named below is not an "ineligible Contractor" as set forth in G.S, 143-59,1(a)because: (a) Neither the Contractor nor any of its affiliates has 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 tile, sales met one of more of the conditions of G.S. 105-164.9(b), and ....:CQhsak..pn ' ft)ie.ftal4wghaxtsj Neither the Contractor nor any of its affiliates has incorporated or reincorporated in a "tax haven country" as set forth in G.S. 143-59,1(c)(2)after December 31,2001;or * The Contractor or one of Its affiliates has incorporated or reincorporated in a "tax haven country" as set forth in G.S. 143-59.1(c)(2) after December 31, 2001 but the United States is not the principal rnarlcet for the public trading of the stock of the corporation incorporated in the tax haven country. (3) Pursuant to G,S, 1.43-59.2(b), the undersigned hereby certifies that none of the Contractor's officers, directors, or owners (if the Contractor is an unincorporated business entity)has been convicted of any violation of Chapter 78A of the General Statutes or the Securities Act of 1933 or the Securities Exchange Act of 1934 within 10 years immediately prior to the date of the bid solicitation. (4) The undersigned hereby cortifras further that, a) He or she is a duly authorized representative of the Contractor named below; b) He or she is authorized to make, and does hereby make,the foregoing certifications on behalf of the Contractor; and c) He or she understands that any person who knowingly submits a false certification in response to the requirements of G.S, 143-59.1and-59.2 shall be guilty of a Class I felony. The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and date this document immediately thereafter. Ql' it oiiirtn pve�i»n1t Girr~iitr „ u'xiae R s iiGa:Deifiri �lt titd Hausl',andluxt t t '.: ��aio itst 8/3/20 Sigrisfhl'�af:iMon#Oo.tor-s AiiihoiiZed Agcnt gate aitiill ert1► x ]7i afors Cririp �uskic .Re [l11 d 'ar tin ? Pi'l 4etlN t t :Q . Qq ...K ttioalzetl Ager:i Title �,wurr, �Iwu 814120 Data 8;rfilt�il.:N�iit�..tiF;YVilftess T. .if# c Tiro witness should be present when tits Contractor's AttlhorInd Agent signs Ads certification and should sign and date this doctunent Inrntediately therenfler. 13