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DIVISION OF EMPLOYMENT SERVICES <br />PLACE OF PERFORMANCE <br />FOR CERTIFICATION REGARDING DRUG-FREE <br />WORKPLACE REQUIREMENTS <br />Name: William Edwards, Jr. <br />Name of Contractor: Queen Beach Printers, Inc. <br />Contractor Number: Tax ID #: 95-2117776 <br />Date: June 07, 2012 <br />The Contractor shall insert in the space provided below the site(s) expected to be used <br />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 site): <br />937 Pine Avenue, Long Beach, LA County, CA 90813 <br />EXHIBIT C <br />