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DocuSign Envelope ID:9A043OD9-7ACC-4C25-8C5E-7A2CO072060E <br /> 11 The site(s) for the performance of work done in connection with the specific agreement ale <br /> listed below: <br /> l. 113 May Street <br /> (Street address) <br /> Hillsboroujzh, Orange,NC, 27278 <br /> (City, county, state, zip code) <br /> 2 _ _ 2501 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 /> DocuSigned by: p <br /> l�''l" � I S ASL Interpreter <br /> ��� .. <br /> Signature Title <br /> 9/11/2015 <br /> Agency/Organization Date <br /> (Certification signature should be same as Contract signature ) <br /> Federal Certification-Dtug-Free Workplace (06/04) Page 2 of 2 <br />