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DocuSign Envelope ID:5FF56C04-3BB8-4567-932F-25B632A40E72 <br /> It. The site(s) for the performance of work done in connection with the specific agreement are <br /> listed below: <br /> 113 Mayo Street <br /> (Street address) <br /> Hillsboroup,h, Orange,NC,27275 <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 terinination of grants, or goveinment-wide Federal suspension or debarment <br /> (Section 4 CFR Part 85, Section 85.615 and 86.620). <br /> Ib <br /> DacuSigned by: <br /> iSS& Sat& <br /> Spanish Interpreter/Translator <br /> D55492B3CA8A41A... <br /> Signature Title <br /> 7/20/2016 <br /> .Agency/Organization Date <br /> (Certification signature should be same as Contract signature.) <br /> } <br /> i <br /> Federal Certification-Drug-Free Workplace(06/04) Page 2 of 2 <br />