2021-206-E- NC DEPT OF HEALTH & HUMAN SERVICES-To prevent teen pregency

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DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6 DocuSign Envelope ID:90846844-6A46-0456-9ABC-788993474441 State Certifications Contract Number 00042091 /Page 26 of 26 Contractor Certifications Required by North Carolina Law 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: hap:f/www.ncga.state.nc.us/EnactedLegislation/Statutes/PDFByArticle/Chapter_64/Articie_2.pdf. G.S. 133-32: http:/hvww.ncga.state,nc.us/gaserip(s/statutes/statutelookup.Pi?statute=133-32 • Executive Order No.24(Perdue,Gov.,Oct. 1,2009): http://Www,othicscotnmission.nc.gov/library/Pdfs/LawsIE024,pdf • G.S. 105-164.8(b): http://www,ncga.state,ne.us/EnactedLegislation/Statutes/Pl)F(3ySectiorl/Chapter IOS/GS_105-164.8.pdf • G.S. 143-48.5: http://www.ncga.state.ne.us/P-nactedLegislation/Statutes/HTML/BySection/Chapter-143/GS_143-49.5.htrnl • G.S, 143-59.1: htip://www.ncga_state.nc.us/EnnetedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-59,1,pdf • G.S, 143-59.2: http://www.ncga.state.nc,us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-59.2.pdf w • G.S. 143-133.3: http://ww.nega.state.nc.us/EnactedLegislettion/Statutes/I-ThTL/BySection/Chapter_143/G5_143-133.3.htn11 • G.S. 143B-139.6C: http://www.ncga.state,ne.us/EnactedLegislation/Statttes/PDFBySection/Chapter_143B/GS_143B-139.6C.pdf Certifications (1) Pursuant to G.S.'1.33-32 and Executive Order No.24 after December 31, 2001 but the United States (Perdue, Gov., Oct. 1, 2009), the undersigned hereby is not the principal market for the public trading certifies that the Contractor named below is in of the stock of the corporation incorporated in compliance with, and has not violated,the provisions of the tax haven country. either said statute or Executive Order. (4) Pursuant to G.S. 143-59.2(b), the undersigned hereby (2) Pursuant to G.S. 143-48.5 and G.S. 143-133.3, the certifies that none of the Contractor's officers, undersigned hereby certifies that the Contractor named directors, or owners (if the Contractor is an below, and the Contractor's subcontractors, complies unincorporated business entity) has been convicted of with the requirements of Article 2 of Chapter 64 of the any violation of Chapter 78A of the General Statutes or NC General Statutes, including the requirement for the Securities Act of 1933 or the Securities Exchange each employer with more than 25 employees hi North Act of 1934 within 10 years immediately prior to the Carolina to verify the work authorization of its date of the bid solicitation, employees through the federal E-Verify system." E- (5) Pursuant to G.S. 143B-139.6C, the undersigned Verify System Link: www.uscis.gov hereby certifies that the Contractor will not use a (3) Pursuant to G.S. 143-59.1(b), the undersigned hereby former employee, as defined by G.S. 143B- certifies that the Contractor named below is not an 139.6C(d)(2), of the North Carolina Department of "ineligible Contractor" as set forth in G.S. 143-59.1(a) Health and Human Services in the administration of a because: contract with the Department in violation of G.S. (a) Neither the Contractor nor any of its affiliates has 143B-139.6C and that a violation of that statute shall refused to collect the use tax levied under Article 5 void the Agreement. of Chapter 105 of the General Statutes on its sales (6) The undersigned hereby certifies further that: delivered to North Caroluia when the sales met (a) He or she is a duly authorized representative of the one or more of the conditions of G.S. 105- Contractor named below; 164.8(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 9 Neither the Contractor nor any of its affiliates Contractor;and has incorporated or reincorporated in a "tax (c) He or she understands that any person who haven country" as set forth in G.S. 143- knowingly submits a false certification in response 59,1(c)(2)after December 31,2001; or to the requirements of G.S. 143-59.1and -59.2 ❑ The Contractor or one of its affiliates has shall be guilty of a Class I felony. incorporated or reincorporated in a "tax haven country" as set forth in G.S. 143-59.1(c)(2) Contractor's Name; Orange 2 IC*Qvpmment—Oran e County Department of Social Services Contractor's L11:A3r',@1 1S Vt.Lt. 11/18/Z020 Authorized Agent: Signature Date. Printed N 1) M-%"dlb4- ren Title Deputy County Manager ht�SSa Q tSd1n 11/18/2020 Witness: Signature Date setae ... Printed Name Melissa Allison Title Executive Assistant The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and date this document luunediately thereafter. Contractor Certifications Required by North Carolina Law(Rev.612016) Page I of t