2024-008-E-Social Svc-Earle Deleon Whitsett dba Whitsett Enterprise-non-emergency medical transportation

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Contractor Certifications Required by North Carolina Law (Rev. 8/2016) Page 2 of 3 solicitation. (5) Pursuant to G.S. 143B-139.6C, the undersigned hereby certifies that the Contractor will not use a former employee, as defined by G.S. 143B-139.6C(d)(2), of the North Carolina Department of Health and Human Services in the administration of a contract with the Department in violation of G.S. 143B-139.6C and that a violation of that statute shall void the Agreement. (6) The undersigned hereby certifies 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. (1) Pursuant to the Orange County Living Wage Contract’s Policy, the undersigned certifies that the Contractor pays the employees who perform services under this contract a living wage (in Orange County currently $16.60 per/hr.) Check here if contractor pays employees performing under this contract a living wage. If Contractor does not pay employees a living wage, what is the wage that employees performing services under this contract paid? __________________________ The witness should be present when the Contractor’s Authorized Agent signs this certificate and should sign and date the document immediately thereafter. Contractor’s Name: Contractor’s Authorized Agent: Signature Date Printed Name Title Witness: Signature Date Printed Name Title DocuSign Envelope ID: 4D4C41ED-9F19-4257-801C-59178B514BD4 Whitsett Enterprise 12/19/2023 Owner 12/22/2023 Office of the Administrator