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__ Contract #68-2007 <br />~''~ii~uu'~~~ Touched by Angels Home Healthcaze II, Inc. <br />II. The sites for the erformance of~~~~:_ddne in connection with the s ecific a Bement are <br />() P P ~' <br />listed below: <br />(Street address) <br /> <br />,county, state, zip code) <br />2. <br />(Street address) <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 />,. <br />1LLb~ ~:~~~~"fib <br />gnature Title <br />Agency/Org 'on Date <br />(Certification signature should be same as Contract signature.) <br />• <br />Federal Certification -Drug-Free Workplace (06/04) Page 2 of 2 <br />