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Northeast Psychiatric & Psychological Institute <br />II. The site(s) for the performance of work done in connection with the specific agreement are <br />listed below: <br />380 Coppe~eld Blvd. <br />(Street address) <br />Concord, Cabarrus, NC 28025 <br />(City, 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 ofwork under this <br />agreement. <br />False certification or violation of the certification shall be grounds for suspension of payment, <br />suspension or termination'iofgrems, or government-wide Federal suspenston or debarment <br />(Section 4 CFR Part 85, Section 85.615 and 86.620). <br />_ .~j <br />,~' ~ .. LC~1l~t ~~~', (~ti~C-Nt~~r~'7~_~~LI.Ga~_ ~;~Q~ia,vl~ <br />Sign to Title J <br />Northeast Psychiatric Serudces <br />Agency/Organization <br />~~ <br />-Date <br />(Certification signature shquld be same as_Contract signature.) <br />Federal Certification - Arug-Free Workplace (06/04) 'F'_) ~ Page 2 0£ 2 <br />