Nacional Potosi
| # | Player | MIN | G | A | YC | RC | G1h | G2h | IN | OUT |
|---|---|---|---|---|---|---|---|---|---|---|
| Aristides Ramon Florentin SUB | 90 | 0 | 0 | 1 | 0 | 0 | 0 | |||
| Ivan Enrique Huayhuata Romero D | 71 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | ||
| Eliseo Isaías Dury Gómez D | 66 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | ||
| Juan Pablo Aponte Gutiérrez D | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Luis Fernando Martelli Dias D | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Walter Humberto Rioja Ugarte D | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Juan Pablo Alemán Morales D | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Sebastián Darío Carrizo MF | 90 | 0 | 0 | 1 | 0 | 0 | 0 | |||
| Jaime Cardozo Tahua MF | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Rolando Elmer Choque Calisaya MF | 62 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | ||
| Diego Fernando Ardaya Serrate AT | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Marcos Ferrufino D | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Guery García Guzmán SUB | 28 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | ||
| Eloy Padilla Lopez SUB | 24 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | ||
| Pastor Ventura Torrez Quiroz SUB | 19 | 1 | 0 | 0 | 0 | 0 | 1 | 1 | ||
| Miguel Ortiz Pereira D | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Rubén Ángel Panozo MF | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Roberto Paz Jiménez MF | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Yadin Salazar Caballero SUB | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Totals | 1440 | 1 | 0 | 2 | 0 | 0 | 1 | 3 | 3 |
Goal scorers aren't recorded for every goal in this game (1 of 2 attributed).
GV San Jose
| # | Player | MIN | G | A | YC | RC | G1h | G2h | IN | OUT |
|---|---|---|---|---|---|---|---|---|---|---|
| Carlos Emilio Lampe Porras SUB | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Ariel Juárez Montaño D | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Enrique David Díaz Velázquez D | 90 | 1 | 0 | 0 | 0 | 0 | 0 | |||
| Juan Pablo Fernández Méndez D | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Mario Alberto Ovando Padilla MF | 86 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | ||
| Abdón Reyes Cardozo MF | 33 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | ||
| José Marcelo Gomes MF | 90 | 1 | 0 | 0 | 0 | 1 | 0 | |||
| Adán Alexis Félix Bravo MF | 75 | 0 | 0 | 1 | 0 | 0 | 0 | 1 | ||
| Roly Desiderio Sejas Muñoz MF | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Carlos Ariel Neumann Torres AT | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Ronald Segovia Calzadilla AT | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Julio César Baldivieso Rico MF | 90 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| Juan Carlos Zampiery Rivarola SUB | 57 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | ||
| Héctor Ariel Calderón Llave SUB | 15 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | ||
| Carlos Eduardo Vargas Menacho SUB | 4 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | ||
| Totals | 1080 | 2 | 0 | 1 | 0 | 1 | 0 | 3 | 3 |