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DocuSign Envelope ID: 53EDA064- 8713- 4EAA- 828B- 4C2296C1101`6 <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 />UocuSigned by: <br />Signat_- _ DA1CF1 FC5F71404 . <br />Agency /Organization <br />Karen and Burmese interpreter <br />Title <br />7/5/2018 <br />Date <br />(Certification signature should be same as Contract signature.) <br />Federal Certification - Drug -Tree Workplace (06/04) Page 2 of 2 <br />