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Name: <br />Date: <br />PLACE OF PERFORMANCE <br />FOR CERTIFICATION REGARDING DRUG-FREE <br />WORKPLACE REQUIREMENTS <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 />12 A'tvL-,1, , Ill <br />A -n& 10 L d92'�� 6a <br />0r�,� C.c,�_-�-I <br />EXHIBIT E <br />Page 3 of 3 <br />