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DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF <br /> It The site(s) for the performance of work done in connection with the specific agreement are <br /> listed below: <br /> 1 _^ 113 Mayo Street <br /> (Street address) <br /> Hillsborough, Orange,NC, 2'7278 <br /> (City, county, state, zip code) <br /> 2. Homestead Road <br /> (Street address) <br /> _Chapel Hill, Orange, NC 27516 <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 /> L�bVcr , (,t tSc Deborah Kennedy Lei sey <br /> Signature Title <br /> 8/17/2015 <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 />