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Contract #68-2013 <br />Dr. Betty Rintoul <br />II. The site(s) for the performance of work done in connection with the specific agreement are <br />listed below: <br />(Street address) <br />C~Y,,ba~o Nc ~-~SIo <br />(City, 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 />~~, ~ , <br />Signature Title <br /> <br />Agency/Organization <br />b / ~/v ~ <br />Date <br />(Certification signature should be same as Contract signature.) <br />Federal Certification -Drug-Free Workplace (06/04) Page 2 of 2 <br />