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19 <br /> Exhibit C <br /> Sexual Offender Registry Check Certification Form <br /> PLEASE SUBMIT T,F.LIS FORM TO YO UR SCHOOL SYSTEM'S REPRESENTATIVE <br /> Project Name: Efland Cheeks Elementary School Contract Single Prime GC <br /> Renovations <br /> Check the appropriate box to indicate the type of check: <br /> X Initial Supplemental Annual <br /> I, Kacie Loye (insert name), Controller (insert title) of <br /> Lomax Construction Inc. (insert company name) hereby certify that I have performed all of the <br /> required sexual offender registry checks required under this Agreement for all contractual personnel (employees, <br /> agents, ownership personnel, or contractors ) who may be used to deliver goods or provide services under this <br /> Agreement, including the North Carolina Sex Offender and Public Protection Registration Program, the North <br /> Carolina Sexually Violent Predator Registration Program, and the National Sex Offender Registry (Note: all of <br /> the required registry checks may be completed at no cost by accessing the United States Department of Justice <br /> Sex Offender Public Website at http;//www.nsuw.zovn_I finther certify that none of the individuals listed below <br /> appears on any of the above-named registries and that I will not assign any individual to deliver goods or perform <br /> services under this Agreement if said individual appears on any of the sex offender registries_ I agree to maintain <br /> all records and documents associated with these registry checks, and that I will provide such records and <br /> documents to the school system upon request. I specifically acknowledge that the school system retains the right <br /> to audit these records to ensure compliance with this section at any time in the school system's sole discretion. I <br /> acknowledge that I am required to perform these checks and provide this certification form before any work is <br /> performed under the Agreement (initial check), any time additional contractual personnel may perform work <br /> under the Agreement(supplemental check),axed at each anniversary date of the Agreement(annual check). <br /> Contractual Personnel Names Job Title <br /> I. Bobby Weaver Project Manager <br /> 2. Josh Carter Superintendent <br /> 3. Kevin Lewis VP of Operations <br /> 4. Brian Evans Superintendent <br /> 5. <br /> 6. <br /> I attest that the forgoing information is true and accurate to the best of my knowledge_ <br /> T Kacie Love (print name) <br /> 4 1 1 2 0 2 4 _ (sianature/date) <br /> 2101264 <br />