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DocuSign Envelope ID:218BDE7F-0473-4740-91 FB-B8ACB26A75F7 <br /> lI the site(s) for the perf6imance of'work done in connection with the specific agreement ale <br /> listed below: <br /> 1 113 Mayo Street <br /> (Street address) <br /> Hillsborough, Orange,NC 27278 <br /> (City, county, state, zip code) <br /> 2501 Homestead Road _ <br /> (Street address) <br /> Chapel Hill, Oral�gez N27516 _ <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 fart 85, Section 85.615 and 86 620) <br /> DocuSigned by: 1 <br /> �t,LI�AAMtiit, �jt,atlbin, <br /> Spanish Interpreter <br /> Signature Title <br /> 9/1/2015 <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 />