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solicitation. (c) He or she understands that any person who <br /> (5) Pursuant to G.S.143B-139.6C,the undersigned hereby knowingly submits a false certification in response <br /> certifies that the Contractor will not use a former to the requirements of G.S. 143-59.land-59.2 shall <br /> employee,as defined by G.S. 143B-139.6C(d)(2),of the be guilty of a Class I felony. <br /> North Carolina Department of Health and Human <br /> Services in the administration of a contract with the (1) Pursuant to the Orange County Living Wage <br /> Department in violation of G.S. 14313-139.6C and that a Contract's Policy,the undersigned certifies that the <br /> violation of that statute shall void the Agreement. Contractor pays the employees who perform <br /> (6) The undersigned hereby certifies further that: services under this contract a living wage(in Orange <br /> County currently $17.65 per/hr.) Check here ® if <br /> (a) He or she is a duly authorized representative of the contractor pays employees performing under this <br /> Contractor named below; contract a living wage. If Contractor does not pay <br /> employees a living wage, what is the wage that <br /> (b) He or she is authorized to make, and does hereby employees performing services under this contract <br /> make, the foregoing certifications on behalf of the paid. <br /> Contractor; and <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 />