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5 <br /> CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS Page 2 <br /> II.The site(s)for the performance of work done in connection with the specific agreement are listed below: <br /> I. 30D Writ T von Street <br /> (Street address) <br /> Hillsborough, NC 27278 <br /> (City,county,state,zip code) <br /> 2. 2501 Homestead Road <br /> (Street address) <br /> Hhapel Hill, NC 27514 <br /> (City,county,state,zip code) <br /> Contractor will inform the Department 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,suspension <br /> or termination of grants,or government-wide Federal suspension or debarment(Section 4 CFR Part 85, <br /> Section 85.615 and)T.620). <br /> EXECUTED BY <br /> CONTRA OR AU AAORIZED OFFICER <br /> 300 West Tryon Street <br /> ADDRESS 15ATE <br /> Hillsborough, NC 27278 <br /> (Certification signature should be same as Contract signature.) <br />