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<br />DIVISION OF EMPLOYMENT SERVICES <br />PLACE OF PERFORMANCE <br />FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE <br />REQUIREMENTS <br /> <br />Name: Xi/i' ~Y?~~-.3(~c'.;L-- <br />Name of Contractor: ~fi'\(' ,<, ~;:-=- c_.J/".l/(,:::::-e,:o <br />Contractor Number: <br />Date: 1\ / ,0 Ie.}'; <br />/ I <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 />1/b15' <br />c::.,1~o. <br /> <br />C;'. fl.; ,).. L--J <br />(j"""", 04 q ~lO5' <br />C.".~LI <br /> <br />rh"~q <br />