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D'IVISfON OF EMPLOYMENT SERVICES <br />PLACE OF PERFORMANCE <br />FOR CERTIFICATION: REGARDING DRUG -FREE <br />WORKPLACE REQUIREMENTS <br />Name: <br />Name of Contractor: <br />Contract Number: <br />Date: t wrcC_ c <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 />Address <br />EXHIBIT E <br />