Orange County NC Website
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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 />"- <br />T ~ ~-o `r - <br />S ~ ature Title <br />Agency/Organization <br />6lZg <br />Date <br />(Certification signature should be same as Contract signature.) <br />Federal Certificarion -Drug-Free Workplace (06/04) Page 2 of 2 <br />