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DocuSign Envelope ID:92CA6B6A-5CBD-40AE-8FF1-B6100066874C <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,2.7278 <br /> (City, county, state, zip code) <br /> 2. 2501 Homestead Road <br /> (Street address) <br /> Cha el Hill Oran e 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 he 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 /> ssth. Sat& Spanish Interpreter/Translator <br /> D55492B3CASA{1A. <br /> Signature Tide <br /> 6/28/2019 <br /> Agency/Organization Date <br /> (Certification signature should be same as Contract signature.) <br /> Federal Certification-Drug-Free Workplace(06104) Page 2 of 2 <br />