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Cotâ–ºsolidated Agreement FY15 BK:00026 PG-0474 Page 21 of 28 <br />(4) The undersigned hereby certifies further that: <br />(a) He or she is a duly authorized representative of the Contractor named below; <br />(b) He or she is authorized to make, and does hereby make, the foregoing certifications on behalf of the <br />Contractor; and <br />(c) He or she understands that any person who knowingly submits a false certification in response to the <br />requirements of G.S. 143-59.1 and -59.2 shall be guilty of a Class I felony. <br />Lee County Health Department <br />Contractor's Name _ <br />Signature of Contractor's Authorized Agent <br />Date <br />Printed Name of Contractor's Authorized Agent Title <br />Signature of Witness <br />Title <br />Printed Name of Witness Date <br />The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and <br />date this document immediately thereafter. <br />