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DocuSign Envelope ID: E0823671-DC32-4568-94FB-2BF1 B9E36EAD <br /> H. The site(s)for the performance of work done in connection with the specific agreement are <br /> listed below: <br /> 1. 113 Ma ❑ Street <br /> (Street address) <br /> Hillsborough, Orange,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 /> Doc�uSigned by, ! <br /> �s <br /> �a f�. u.t'' Spanish Interpreter <br /> SignatUX',B5B46741 EBE"" Title <br /> 7/3/2019 <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 />