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DIVISION OF EMPLOYMENT SERVICES <br />PLACE OF PERFORMANCE <br />FOR CERTIFICATION REGARDING DRUG-FREE <br />WORKPLACE REQUIREMENTS <br />Name: Victor Rivas <br />Name of Contractor: Americare Resoiratorv Services, Inc. <br />Contractor Number: <br />Date: July 31 , 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 />1920 E. Deere Ave., Suite 11 O <br />Santa Ana. CA 92705 <br />(949) 250-0045x333 <br />EXHIBIT D