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DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E 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://www.ncga.state.nc.us/EnactedLeizislation/Statutes/PDFByArticle/Chapter 64/Article 2.pdf • G.S. 133-32: http://www.ncga.state.nc.us/gaseripts/statutes/statutelookup.pl?statute=133-32 • Executive Order No. 24(Perdue,Gov.,Oct. 1,2009): http://www.ethicscommission.nc.gov/library/pdfs/Laws/E024.pdf • G.S. 105-164.8(b): http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDFBySection/Chgpter 105/GS 105- 164.8.pdf • G.S. 143-48.5: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTMLBySection/ChWter 143/GS 143- 48.5.html • G.S. 143-59.1: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDFBySection/Chapter 143/GS 143- 59.l.pdf • G.S. 143-59.2: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter 143/GS 143- 59.2.pdf • G.S. 143-133.3: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/fITMLBySection/Chapter 143/GS 143- 133.3.html • G.S. 143B-139.6C: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDFBySection/ChVter 143B/GS 143B-139.6C.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 (Perdue, Gov., Oct. 1, 2009), the undersigned hereby (a) Neither the Contractor nor any of its affiliates has certifies that the Contractor named below is in refused to collect the use tax levied under Article 5 compliance with,and has not violated,the provisions of of Chapter 105 of the General Statutes on its sales either said statute or Executive Order. delivered to North Carolina when the sales met (2) Pursuant to G.S. 143-48.5 and G.S. 143-133.3, the one or more of the conditions of G.S. 105- undersigned hereby certifies that the Contractor named 164.8(b); and below, and the Contractor's subcontractors, complies with the requirements of Article 2 of Chapter 64 of the (b) [check one of the following boxes] NC General Statutes, including the requirement for ❑ Neither the Contractor nor any of its affiliates each employer with more than 25 employees in North has incorporated or reincorporated in a "tax Carolina to verify the work authorization of its haven country" as set forth in G.S. 143- employees through the federal E-Verify system." E- 59.1(c)(2)after December 31,2001;or Verify System Link: www.uscis.gov Local government is specifically exempt from Article 2 ❑x The Contractor or one of its affiliates has of Chapter 64 of the North Carolina General incorporated or reincorporated in a "tax haven Statutes. However,local government is subject to and country" as set forth in G.S. 143-59.1(c)(2) must comply with North Carolina General Statute after December 31, 2001 but the United States 153A-99.1,which states in part as follows: is not the principal market for the public trading Counties Must Use E-Verify-Each county shall of the stock of the corporation incorporated in register and participate in E-Verify to verify the work the tax haven country. authorization of new employees hired to work in the (4) Pursuant to G.S. 143-59.2(b), the undersigned hereby United States. certifies that none of the Contractor's officers, (3) Pursuant to G.S. 143-59.1(b), the undersigned hereby directors, or owners (if the Contractor is an certifies that the Contractor named below is not an unincorporated business entity) has been convicted of "ineligible Contractor" as set forth in G.S. 143-59.1(a) any violation of Chapter 78A of the General Statutes or because: the Securities Act of 1933 or the Securities Exchange Contractor Certifications Required by North Carolina Law(Rev.8/2016) Page 1 of 3