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DocuSign Envelope ID: OE2F9DBB- D657- 45AD- B508- 556F4AE3530B <br />Il. The site(s) for the performance of work done in connection with the specific agreement are <br />listed below: <br />1. 113 Ma o Street <br />(Street address) <br />Hillsborough, i, Oran e, NC, 27278 <br />(City, county, state, zip code) <br />2. 2501 Homestead Road <br />(Street address) <br />Cha el 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 />Docu5igned by: <br />Signature D554B2BSCASA41A_. <br />Agency /Organization <br />Title <br />Date <br />Spanish Interpreter /Translator <br />7/3/2018 <br />(Certification signature should be same as Contract signature.) <br />Federal Certification - Drug -Free Workplace (06/04) Page 2 of 2 <br />