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DocuSign Envelope ID: 70B14FB4 -AE32- 4116- 89EE- 5DA48DF2569C <br />11. The site(s) for the performance of work done in connection with the specific agreement are <br />listed below: <br />1, 113 Mao 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 government -wide Federal suspension or debarment <br />(Section 4 CFR Part 85, Section 85.615 and 86.620), <br />Dom Signed by, <br />�t [, f [. r � tU�Rj Program Director/co-owner <br />Signat __ _a2s72CO9783445E. Title <br />CHICLE- Perla Saitz 7/6/2018 <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 />