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DocuSign Envelope ID:A70900D0-A55E-4E6C-87AE-D788DF2AC51 C <br /> II The site(s) for the performance of work done in connection with the specific agreement are <br /> listed below: <br /> 1 _ 113 Mateo Street <br /> (Street address) <br /> _ Hillsborough, Orarnge,NC, 27278 <br /> (City, county, state, zip code) <br /> 2. _ 2501 Homestead Road <br /> (Street address) <br /> Chanel 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 uSigned by: <br /> � Spanish translator/interpreter <br /> €458 K1474.. <br /> Signature Title <br /> 8/18/2015 <br /> Agency/Organization Date <br /> {Certification signature should be same as Contract signature ) <br /> Federal Certification-Drug-Free Workplace(06104) Page 2 of 2 <br />