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DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E <br /> Act of 1934 within 10 years immediately prior to the (c) He or she understands that any person who <br /> date of the bid solicitation. knowingly submits a false certification in response <br /> (5) Pursuant to G.S. 143B-139.6C, the undersigned to the requirements of G.S. 143-59.1and -59.2 <br /> hereby certifies that the Contractor will not use a shall be guilty of a Class I felony. <br /> former employee, as defined by G.S. 14313- <br /> 139.6C(d)(2), of the North Carolina Department of (1) Pursuant to the Orange County Living Wage <br /> Health and Human Services in the administration of a Contract's Policy, the undersigned certifies that <br /> contract with the Department in violation of G.S. 14313- the Contractor pays the employees who perform <br /> 139.6C and that a violation of that statute shall void the services under this contract a living wage (in <br /> Agreement. Orange County currently $14.95 per/hr.) Check <br /> (6) The undersigned hereby certifies further that: here ❑ if contractor pays employees performing <br /> under this contract a living wage. If Contractor <br /> (a) He or she is a duly authorized representative of the does not pay employees a living wage, what is the <br /> Contractor named below; wage that employees performing services under this <br /> contract paid? <br /> (b) He or she is authorized to make, and does hereby <br /> make, the foregoing certifications on behalf of the <br /> Contractor; and <br /> Contractor's <br /> Name: CNC/Access, INc. dba All Ways Caring HomeCare <br /> Contractor's DocuSigned by: <br /> Authorized Esbv,� �1Agent: Signature � � ��1 Date 12/22/2021 <br /> Printed Sherry Pemberton VP HomeCare Contracts & Sales <br /> Name Docu'I _ wltSbV <br /> Signed by: Title <br /> f�C <br /> Witness: Signature Date 12/22/2021 <br /> e1s <br /> Printed Heather Wilson National Credentialing Manager <br /> Name Title <br /> The witness should be present when the Contractor's Authorized Agent signs this certificate and should sign and <br /> date the document immediately thereafter. <br /> Contractor Certifications Required by North Carolina Law(Rev.8/2016) Paae 2 of 3 <br />