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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 /> 1. <br /> (Street address) <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 /> WV1 <br /> Signature Title <br /> Agency/Organization Date <br /> (Certification signature should be same as Contract signature.) <br /> Federal Certification-Drug-Free Workplace(06/04) Page 2 of 2 <br />