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State Certifications Contractor Certifications Required by North Carolina Law Instructions The person who signs this document should read the text of the statutes listed below and consult with counsel and other knowledgeable persons before sighing. The text of each North Carolina General Statutes can be found online at: • Article 2 of Chapter 64: http: // www. ncga. state.ne.us /EnactedLegislation/ Statutes /PDF/ByAj icle /Chapter�64 /Article 2.1?df • G.S. 105- 164.8(b). http: / /wNvrv.ncga. state. ne. us/ EnactedLe, gisl ation /Statutes/PDFBySection/Chapter 105/GS_105- 164.8.pdf • G.S. 143 -48.5: http: / /wwvw.ncya. state. nc. us /EuactedLcaislation/ Statutes /HTML /BySection/Cliapter�143 /GS 143- 48.5,html • G.S. 143 -59.1: http: / /www.nega. state. uc. us/ EuactedLe2islation /Statutes/PDFBySection/Cbapter 1431GS 143- 59.1.pdf • G.S. 143 -59.2: fiLtp://www.nega.state.nc,us/EnactedLep 143 59.2�df • G.S. 147 - 33.95(8 ): http: / /www. ncga. state .rrc.us/EnactedLegislation/ Statutes /fITML/BySection/Cliapter_ 147 /GS 147- 33.95.html Certifications (1) Pursuant to G.S. 143 -48.5 and G.S. 147 33.95(g), the undersigned hereby certifies that the Contractor named below, and the Contractor's subcontractors, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer with more than 25 employees in North Carolina to verify the work authorization of its employees through the federal E- Verify system." E- Verify System Lime www.uscis. og_v (2) Pursuant to G.S. 143- 59.1(b), the undersigned hereby certifies that the Contractor named below is not an "ineligible Contractor" as set forth in G.S. 143- 59.1(a) because: (a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied under Article 5 of Chapter 105 of the General Statutes on its sales delivered to North Carolina when the sales met one or more of the conditions of G.S. 105- 164.8(b); and (b) [check one of the following boxes] ❑ Neither the Contractor nor any of its affiliates has incorporated or reincorporated in a "tax haven country" as set forth in G.S. 143- 59.1(c)(2) after December 31, 2001; or ❑ The Contractor or one of its affiliates has incorporated or reincorporated in a "tax haven. country" as set forth in G.S. 143- 59.1(c)(2) after December 31, 2001 but the United States is not the principal marl et for the public trading of the stock of the corporation incorporated in the tax haven country. (3) Pursuant to G.S. 143- 59.2(b), the undersigned hereby certifies that none of the Contractor's officers, directors, or owners (if the Contractor is an unincorporated business entity) has been convicted of any violation of Chapter 78A of the General Statutcs or the Sceuritics Act of 1933 or the Securities Exchange Act of 1934 within 10 years immediately prior to the date of the bid solicitation. (4) The undersigned hereby certifies fin that: 1. He or she is a duly authorized representative of the Contractor named below; 2. He or she is authorized to make, and does hereby snake, the foregoing certifications on behalf of the Contractor - ; and 3. He or she understands that any person who lmowingly submits a :false certification in response to the requirements of G.S. 143-59. land -59.2 sball be guilty of a Class I felony. Signature of Witness 4ffAlw�j Z &,L, APHM raRATM5 AS29sr44F Printed Name of W� Title The witness should be present when the Contractor's Authorized Agent signs this certification and should sib and date this document immediately thereafter. Attachment number 1 Contractor Certifications Required by North Carolina Law (rev. 1012014) F - Pagel21� of 1 Stanley Wilson 64::U Te 0E ,)l&tC�A Printed Name of Contractor's Authorized Agent Tit1c