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Docusign Envelope ID: 50585F21 -A738A303-BD3F-60841076ED5E <br /> State Certifications Contract Number 00048145 / Page 30 of 30 <br /> Grantee/Contractor Certifications Required by North Carolina Law <br /> Instructions : The person who signs this document should read the text of the statutes and Executive Order listed below and consult <br /> with counsel and other knowledgeable persons before signing. The text of each North Carolina General Statutes and of the Executive <br /> Order can be found online at : <br /> • Article 2 of Chapter 64: http ://www.ncga ,state.nc.to/EnactedLegislation/Statt tesZPDFBvArticle/Chapter 64/Article 2 ,pdf <br /> • G. S . 133 -32 : htto ://www.ncga . state.nc .its/gascripts/stahrtes/statiitelookiM.pl?statute= l33 -32 <br /> • Executive Order No. 24 (Perdue, Gov. , Oct. 1 , 2009) : https ://ethics.nc . gov/media/242/download?attachment <br /> • G. S . 105464. 8 (b) : http://wwrv.iicga state nc us/EnactedLeOslation/Stahrtes/PDFBy5ection/Chapter 105/GS 105 - 164 . 8.af <br /> • G. S . 14348 . 5 : httn ://wvvw.ncga.state,nc.us/EnactedLegistation/Statutes/1-TTMIJBySection/Chapter_143/GS 14348 . 5 .1itm1 <br /> • G. S . 143 -59 . 1 : http://wr%vw.ncga.state.nc.us/EnactedLeeaslation/Statutes/PDFBySection/Chauter 143/GS 143 -59. 1 .pdf <br /> • G. S . 143 -59 . 2 : http :/Avww.ncga. state.nc.us/EnactedLegislation/Stattites/PDFBySection/Chapter 143/GS 143 -59?.ydf <br /> • G. S . 143433 . 3 : http ://wwrv.ncsa.state.nc .us/EnactedLeeislation/Statutes/HT1vIIJBVSectioiVChapter 143/GS 143433 . 311tm1 <br /> • G. S . 143B439 .6C : http://tvww.ncaa. state.nc.us/EnactedLeeislation/Statiites/PDFBySection/Chapter 143B/GS 143B - 139.6C.pdf <br /> Certifications <br /> ( 1 ) Pursuant to G.S. 133-32 and Executive Order No. 24 country" as set forth in G. S . 143 -59 . 1 (c)(2) after <br /> (Perdue, Gov., Oct. 1 , 2009), the undersigned hereby certifies December 31 , 2001 but the United States is not the <br /> that the Grantee/Contractor named below is in compliance principal market for the public trading of the stock of <br /> with, and has not violated, the provisions of either said statute the corporation incorporated in the tax haven country. <br /> or Executive Order. (4) Pursuant to G.S. 143-59 . 2(b), the undersigned hereby <br /> (2) Pursuant to G.S. 143-48.5 and G.S . 143-133 .3, the certifies that none of the Grantee/Contractor's officers, <br /> undersigned hereby certifies that the Grantee/Contactor directors, or owners (if the Grantee/Contractor is an <br /> named below, and the Grantee/Contractor' s subcontractors, unincorporated business entity) has been convicted of any <br /> complies with the requirements of Article 2 of Chapter 64 of violation of Chapter 78A of the General Statutes or the <br /> the NC General Statutes, including the requirement for each Securities Act of 1933 or the Securities Exchange Act of 1934 <br /> employer with more than 25 employees in North Carolina to within 10 years immediately prior to the date of the bid <br /> verify the work authorization of its employees through the solicitation. <br /> federal E-Verify system. " E-Verify System Link: (5 ) Pursuant to G.S. 143B-139.6C, the undersigned hereby <br /> www.uscis. e°v certifies that the Grautee/Contractor will not use a former <br /> (3 ) Pursuant to G. S. 143 -59.1 (b), the undersigned hereby employee, as defined by G. S. 143B - 139.6C(d)(2), of the North <br /> certifies that the Grantee/Contactor named below is not an Carolina Department of Health and Human Services in the <br /> "ineligible Grantee/Contractor" as set forth in G. S . 143 - administration of a contact with the Department in violation <br /> 59. 1 (a) because : of G. S . 143B- 139. 6C and that a violation of that statute shall <br /> (a) Neither the Grantee/Contactor nor any of its affiliates void the Agreement. <br /> has refiised to collect the use tax levied under Article 5 (6) The undersigned hereby certifies further that: <br /> of Chapter 105 of the General Statutes on its sales (a) He or she is a duly authorized representative of the <br /> delivered to North Carolina when the sales met one or Grantee/Contactor named below: <br /> more of the conditions of G. S . 105 - 164. 8(b) a and (U) He or she is authorized to make, and does hereby make, <br /> (b) [check one of the following boxes] the foregoing certifications on behalf of the <br /> ® Neither the Grantee/Contactor nor any of its Grantee/Contactor; and <br /> affiliates has incorporated or reincorporated in a "tax (C) He or she understands that any person who knowingly <br /> haven county" as set forth in G. S . 143 -59. 1 (c)(2) submits a false certification in response to the <br /> after December 31 , 2001 ; or requirements of G. S. 143 -59. land -59 .2 shall be guilty <br /> ❑ The Grantee/Contractor or one of its affiliates has of a Class I felony. <br /> incorporated or reincorporated in a "tax haven <br /> Grantee/Contractor' s <br /> Name: Oran e & NFb : <br /> Grantee/Contractor' s fiVautilS A4 VtA& 1/ 16/2025 <br /> Authorized Agent: Signature Date <br /> Printed N �i'gffis n Title County Manager <br /> SSa Q SbVi 1/17/202 5 <br /> Witness : Signature Date <br /> Printed Name Melissa Allison Title Business Officer <br /> The witness should be present when the Grantee/Contractor' s Authorized Agent signs this certification and should sign and date this <br /> document irmnediately thereafter. <br /> Contractor Certifications Required by North Carolina Law (Rev. 8/16;3/22;8/24) Page 1 of 1 <br />