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<br />DIVISION OF EMPLOYMENT SERVICES <br />PLACE OF PERFORMANCE <br />FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE <br />REQUIREMENTS <br /> <br />......-r- .- <br /> <br />Name: it/lit!'" Sa/7 ,!05J2, <br />- <br /> <br />Name of Contractor: <br />Contractor Number: <br /> <br />Date: <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 />60/ IV !5r()aj';J St-rk ~ G/l 9J-7tf/ <br />'6/0 Af, 4i/JQ' . {jprtf-- ~ OIl- 1~70/ <br />'t~ /J. l6;n1Ld-~ ;;'111-<<- ~. {JA ~'7dl <br /> <br />