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<br />DIVISION OF EMPLOYMENT SERVICES <br />PLACE OF PERFORMANCE <br />FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE <br />REQUIREMENTS <br /> <br />Date: <br /> <br />fa,/jev-- l~ :];50 <br />c3/skrs of 81. ('J;5(!vL <br />c;?-/~t/:3ag3 I <br />tlr ~~-~~ <br /> <br />Name: <br /> <br />Name of Contractor: <br /> <br />Contractor Number: <br /> <br />The Contractor shall insert in the space provided below the site(s) expected to be <br />used for the performance of work under the contract covered by the certification: <br /> <br />Place of Performance (include street address, city, county, state, zip code for each <br />site): <br /> <br />ibl-fj 23~,~ ~ t; f1 ~701 <br />'/0 . ~/'rJ ' .4rw.- I 701 <br /> <br />EXHIBIT F <br />