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DIVISION OF EMPLOYMENT SERVICES <br />PLACE OF PERFORMANCE <br />FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE <br />REQUIREMENTS <br />Name: ~~r= J~wK,r~c. -Nuw.~ <br />Name of Contractor: O~z (~vv.lT Ckildve~'s Tllevr ae~~i~ A/fs Lr.1-cr <br />Contractor Number: <br />Date: <br />t- 3 - ab <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 />Place of Performance (include street address, city, county, state, zip code for each <br />site): <br />a~ N• f3YO~~~~ <br />5~.~..~~ C-e-~u cv~ aa> o I <br />- , GC~'~ <br />Q^'~-~ <br />