Orange County NC Website
Browse       Search
Contract#68-2004 <br /> Personalized Patient Home Assistance,Inc. <br /> II. The site(s) for the performance of work done in connection with the specific agreement are <br /> listed below: <br /> 1. lad co c .A _Dv-k✓'­v— <br /> (Street address) <br /> (City, county, state,,0i 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 /> C� <br /> Signature Title <br /> 0)_ 4AA���� &--2-3-1 C> <br /> �" -I P)j4.jj4V 1 <br /> Agency/Organ' ion Date <br /> (Certification signature should be same as Contract signature.) <br /> Federal Certification-Drug-Free Workplace(06/04) Page 2 of 2 <br />