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Agenda - 06-18-2024; 8-h - In-Home Aide Contract with Medisolutions, Inc.
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Agenda - 06-18-2024; 8-h - In-Home Aide Contract with Medisolutions, Inc.
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6/13/2024 2:45:42 PM
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BOCC
Date
6/18/2024
Meeting Type
Business
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Agenda
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8-h
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26 <br /> Sfiate Grant Certification - No Overdue Tax Debts <br /> ................... . _............ _.. <br /> Instructions:.. Grantee/Contractor should complete this certification for all state funds received. Entity should <br /> enter appropriate data in the yellow highlighted areas. The completed and signed form should be <br /> provided to the state agency funding the grant to be attached to the contract for the grant funds. A <br /> copy of this form,along with the completed contract,should be kept by the funding agency and <br /> available for review by the Office of State Budget and Management. <br /> Note: /j,+-ore herke a co,ttrai 1 drat c>.xter�dc r>zarrr t/tart rrra°strut 1,�+c`a;year.}zwt i+il1 rr,r>c!to obtrrrr�rra rq�ilcrtrrf crv7r'Picutiurr j<r <br /> cuc.h vr:ur r'+t;fm corrtrtrct. <br /> Medisolutions, Inc <br /> 1146 N. Church Street <br /> Burlington, NC. 27217 <br /> Date of Certification 05/0112024 <br /> To: Nancy Coston, Director, Orange County Department of Social Services <br /> Certification: <br /> We certify that Medisolutions, Inc does not have any overdue tax debts, as defined by N.C.G.S. 105- <br /> 243.1, at the federal, State, or local level. We further understand that any person who makes a false <br /> statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided <br /> by N.C.G.S.) 143C-10-1b, <br /> Sworn Statement: <br /> John Okafor and Oswald Nwogbo being duly sworn, say that we are the Board Chair and Chief <br /> Operating Officer, respectively, of Medisolutions. Inc of Burlington in the State of North Carolina, and <br /> that the foregoing certification is true, accurate and complete to the best of our knowledge and was <br /> made and subscribed by us. We also acknowledge and understand that any misuse of State funds <br /> will be reported to t e appropriate authorities for further action. <br /> Board it t <br /> Sworn to and subscribed before me on the day of the date of said certification. <br /> Wxxida Leak <br /> ` Notary Public <br /> Duftm Gmft_Worth Cwoiw My Commission Expires: <br /> (Notary Si ature and omm"I*n Exores Aptil 2 2025 <br /> If there are any questions,please contact the state agency that provided your grant. if needed,you may contact the North <br /> Carolina Office of State Budget and Management: <br /> NCGrants@osbm.nc.gov-(919)807-4795 <br /> i G,S. 105-243.1 defines: Overdue tax debt.—Any part of a tax debt that remains unpaid 90 days or more after <br /> the notice of final assessment was mailed to the taxpayer. The term does not include a tax debt,however, if the <br /> taxpayer entered into an installment agreement for the tax debt under G.S. 105-237 within 90 days after the <br /> notice of final assessment was mailed and has not failed to make any payments due under the installment <br /> agreement." <br /> __....__..._................. _ <br /> Page 1 of 1 <br /> MS&NCO Form 0008 <br /> Eff.July 1,2005 <br /> Revised July 18,2006,7/07,8/09,9/11 <br />
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