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certifies that the Contractor will not use a former (c) He or she understands that any person who <br /> employee,as defined by G.S. 143B-139.6C(d)(2),of the knowingly submits a false certification in response <br /> North Carolina Department of Health and Human to the requirements of G.S. 143-59.land-59.2 shall <br /> Services in the administration of a contract with the be guilty of a Class I felony. <br /> Department in violation of G.S. 14313-139.6C and that a <br /> violation of that statute shall void the Agreement. (1) Pursuant to the Orange County Living Wage <br /> (6) The undersigned hereby certifies further that: Contract's Policy,the undersigned certifies that the <br /> Contractor pays the employees who perform <br /> (a) He or she is a duly authorized representative of the services under this contract a living wage(in Orange <br /> Contractor named below; County currently $17.65 per/hr.) Check here ® if <br /> contractor pays employees performing under this <br /> (b) He or she is authorized to make, and does hereby contract a living wage. If Contractor does not pay <br /> make, the foregoing certifications on behalf of the employees a living wage, what is the wage that <br /> Contractor; and employees performing services under this contract <br /> paid? <br /> Contractor's <br /> Name: <br /> Contractor's <br /> Authorized <br /> Agent: Signature Date <br /> Printed <br /> Name Title <br /> Witness: Signature Date <br /> Printed <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) Page 2 of 3 <br />