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DIVISION OF EMPLOYMENT SERVICES <br />PLACE OF PERFORMANCE <br />FOR CERTIFICATION REGARDING DRUG -FREE <br />WORKPLACE REQUIREMENTS <br />Name: <br />Name of Contractor: <br />Contractor Number: <br />Date: <br />The Contractor shall Insert In the space provided below the sito(s) expected to be used <br />for the performance of work under the contract covered by the certificatlon: <br />Place of Performance (Include street address, city, county, state, zip code for each site): <br />t EXHIBIT C <br />SAC -16 -004 <br />