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<br />Federal Certification - Drug-Free Workplace (06/04) Page 2 of 2 <br /> <br />II. The site(s) for the performance of work done in connection with the specific agreement are <br />listed below: <br /> <br /> 1. __________ 113 Mayo Street______________________ <br /> (Street address) <br /> <br /> ___________Hillsborough, Orange, NC, 27278 ____________ <br /> (City, county, state, zip code) <br /> <br /> 2. _____________2501 Homestead Road____________________ <br /> (Street address) <br /> <br /> ___________Chapel Hill, Orange, NC, 27516______________ <br /> (City, county, state, zip code) <br /> <br />Contractor will inform the County of any additional sites for performance of work under this <br />agreement. <br /> <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 /> <br /> <br /> <br />_________________________________ __________________________________ <br />Signature Title <br /> <br /> <br />_________________________________ __________________________________ <br />Agency/Organization Date <br /> <br /> <br />(Certification signature should be same as Contract signature.) <br /> <br /> <br />Docusign Envelope ID: F61646AD-0527-4013-B0F0-33E475BDEA6C <br />In Process <br />Docusign Envelope ID: 8B72A5FD-2AA8-4E10-81E4-861D9594AAFE <br />Program Director/Co-Owner <br />CHICLE LANGUAGE INSTITUTE 6/2/2025