Orange County NC Website
Browse       Search
DocuSign Envelope ID:98CAB32E-1814-4C97-B61E-B14BE79B81EA <br /> Orange County, North Carolina <br /> Lake Orange Erosion Control Barrier Replacement <br /> *•*** Contractor.Vendor or Bidder Return This Form With All Other Reauired Documentation***** <br /> 1RAN DIVESTMENT ACT CERTIFICATION REQUIRED BY N.C.C.S. <br /> 143C-6A-5(a) <br /> Name of Contractor,Vendor or Bidder: FSC I/, LLL F,cEoi i7*! � <br /> As of thedate listed below,thecontractor,vendor or bidder listed above,and all subcontractors <br /> utilized bythe contractor,vendoror bidder listed above,is not listed on the Final Divestment list <br /> created bythe State Treasurer pursuant to N.C.G.S. 143-6A-4. <br /> The undersigned hereby certifies that heor she is authorized by the contractor, vendoror bidder <br /> listed above to make the foregoing statement. <br /> Z-2. <br /> i/ .3o Z2o2J <br /> Signature Date <br /> %Nar►45 T- u ow�rs��., ,jam. (/�c� s��rE.s,�s,�-T <br /> Printed Name Title <br /> Notes to persons signing this form: <br /> N.C.G.S. 143C-6A-5(a) requires this certification for bids or contracts with the State of North Carolina, a North <br /> Carolina local government,or any other political subdivision of the State of North Carolina.The certification is <br /> required at the following times: <br /> When a bid is submitted <br /> WW hen a contract is entered into(if the certification was not already made when the vendor <br /> made its bid) <br />