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Contract #68-2008 <br />Home Health Solutions, Inc. <br />• II. The site(s) for the performance of work done in connection with the specific agreement are <br />_i_(2_~c.7~O 1L. <br />Signature Title <br />listed below: <br />1. 1~y s. c sus ~2. sw k- !~~ <br />(Street address) <br />( ity, county, state, zip code} <br />2. <br />(Street address) <br />(City, county, state, zip code) <br />Contractor will inform the County of any additional sites for performance of work under this <br />agreement. <br />False certification or violation of the certification shall be grounds for suspension of payment, <br />suspension or termination of grants, or government-wide Federal suspension or debarment <br />(Section 4 CFR Part 85, Section 85.615 and 86.620). <br />~'}' fl ~wE ~~~L.'~-! ~d c..ca ~ c~-v~ ,:t~.rc. Co ~ 2t / ?-~~'7 <br />Agency/Organization Date <br />(Certification signature should be same as Contract signature.) <br />~. <br />Federal Certification -Drug-Free Workplace (Ob/04) Page 2 of 2 <br />