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Lutheran Family Services in the Carolinas <br />II. The site(s) for the performance of work done in connection with the specific agreement are <br />listed below: <br />1. 173 Spring St. <br />(Street address) <br />Concord, Cabarrus, NC 28025 <br />(City, county, state, zip code) <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 />Palle 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 />Signature <br />Title <br />Lutheran Familv Services in the Carolinas_ ~} - / 7. p 7 <br />Agency/Organization Date <br />(Certification signature should be same as Contract signature.) <br />Federal Certification -Drug-Free Workplace (06/04) ~ _ ~ Page 2 of 2 <br />