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Contract #68-2005 <br />Arcadia Health Services, Inc. <br />II. The site(s) for the performance of work done in connection with the specific agreement are <br />listed below: <br />1 101 North Third Street <br />(Street address) <br />Mebane, NC 27302 <br />(City, county, state, zip code) <br />(Street address) <br />2 <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 Par~S, Section 85.615 and 86.620). <br />Signature <br />Executive Vice President <br />Title <br />Arcadia Health Services, Inc. June Y6,`20T0 <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 />