OTHER-2024-045 In-Home Aide Contract with Medisolutions, Inc

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Docusign Envelope ID:529084AE-3510-4F14-BBF8-4F8B38300ABA State Grant Certification - No Overdue Tax Debts ................. . _._......._.._____ ___..__ _........_...__ Instructions: Grantee/Contractor should complete this certification for all state funds received. Entity should enter appropriate data in the yellow highlighted areas. The completed and signed form should be provided to the state agency funding the grant to be attached to the contract for the grant funds. A copy of this form,along with the completed contract,should be kept by the funding agency and available for review by the Office of State Budget and Management. Now: /j,vou/cure a cowlwei that extends nuw,e t/tart one,state fi scal.vear,YOU xa ifl ne"d rn obtuin an rrhilarerf crrtiJr`cntiurr/or ctc61 vcar op 1Mc cr»rtract. Medisolutions, Inc 1146 N. Church Street Burlington, NC. 27217 Date of Certification 05/01/2024 To: Nancy Coston, Director, Orange County Department of Social Services Certification: We certify that Medisolutions, Inc does not have any overdue tax debts, as defined by N.C.G.S. 105- 243.1, at the federal, State, or local level. We further understand that any person who makes a false statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S.) 143C-10-1b, Sworn Statement: John Okafor and Oswald Nwogbo being duly sworn, say that we are the Board Chair and Chief Operating Officer, respectively, of Medisolutions, Inc of Burlington in the State of North Carolina; and that the foregoing certification is true, accurate and complete to the best of our knowledge and was made and subscribed by us. We also acknowledge and understand that any misuse of State funds will be reported to t e appropriate authorities for further action. Board it i 60-0 Sworn to and subscribed before me on the day of the date of said certification. 1 Notary Public , %W*OWD&W My Commission Expires.- (Notary Sicyature and 9dVqommWIon ExOno Apxil 2 2025 If there are any questions,please contact the state agency that provided your grant. If needed,you may contact the North Carolina Office of State Budget and Management: NCGrants@osbm.nc.gov-(919)807-4795 i G,S. 105-243.1 defines: Overdue tax debt.—Any part of a tax debt that remains unpaid 90 days or more after the notice of final assessment was mailed to the taxpayer. The term does not include a tax debt,however, if the taxpayer entered into an installment agreement for the tax debt under G.S. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement." ...._.............................___- --.---__............._ Page 1 of I MS&NCO Form 0008 Eff.July 1,2005 Revised July 18,2006,7/07,8/09,9/11