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FOR CERTIFICATION REGARDING DRUG-FREE <br />WORKPLACE REQUIREMENTS <br />Name: <br />Date: _ Tuly 1, 2016 <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 />Council On Aging OC - 2 Executive Circle, Suite 175, Irvine, CA 92614 <br />Santa Ana Senior Center - 424 W 3rd Street, Santa Ana, Orange, CA 92701 <br />Southwest Senior Center - 2201 W McFadden Avenue, Santa Ana, Orange, CA 92704 <br />Social Security Office - 1851 E First Street, Fifth Floor, Santa Ana, Orange, CA 92701 <br />EXHIBIT E <br />Page 3 of 3 <br />