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Contract #68-2001 <br />Northen Blue, L.L.P. <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 />(City, county, state, zip code) <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 />Y l~ <br />Si a re <br />~Q <br />Title <br />Agency/Organization <br />Date <br />(Certification signature should be same as Contract signature.) <br />Federal Certification -Drug-Free Workplace (06/04) Page 2 of 2 <br />