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DIVISION OF EMPLOYMENT SERVICES <br />PLACE OF PERFORMANCE <br />FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE <br />REQUIREMENTS <br />Name: Mike Marriner <br />Name of Contractor: Roadtrip Nation Org. <br />Contractor Number: <br />Date: 1/3/2013 <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 />853 W. 17th Street. Unit A, Costa Mesa, Orange, CA 92627 <br />EXHIBIT C <br />SVI-115212v2 20