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<br />Contract # <br />(Contractor) <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. <br /> <br />2315 MvronDrive <br />(Street address) <br /> <br />Raleigh, NC 27607 <br />(City, county, state, zip code) <br /> <br />2. <br /> <br />(Street address) <br /> <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 />?(Q5\JuU--\ ~O <br />Title <br /> <br />1-du Gw~ Urf f\})(fh lMOl1wJ1t. 7--- t& ---0 (., <br />Agency/Organization Date <br /> <br />(Certification signature should be same as Contract signature.) <br /> <br />Federal Certification - Drug-Free Workplace (06/04) <br /> <br />Page 2 of2 <br /> <br />F"-/5 <br />