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DocuSign Envelope ID: C6F7BCA9-9E69-42C5-B5EE-FD39B8B2CEC5 <br /> II. 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, 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 <br /> government-wide Federal suspension or debarment <br /> (Section 4 CFR Part 85, Section 85.615 and 86.620). <br /> DocuSigned by <br /> Program Director/co-owner <br /> BEW-44F2DB5748C... <br /> Signature Title <br /> chapel Hill Institute of cultural and Laii,gL0alucation <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 />