1-Drug Free Workplace Form.doc
DOC document 27 KB Posted
- Attached to
- Rescue Disinfectant
- Solicitation number
- ITB-26-00213
- Issued by
- Hillsborough County, Florida
About this file
This is a Drug-Free Workplace Certification Form required by the Hillsborough County Board of County Commissioners in Florida for the Rescue Disinfectant supply contract. Vendors bidding on this two-year contract, estimated at $145,200.00, must complete and sign this certification to demonstrate compliance with Florida Statute 287.087. The form requires vendors to establish and maintain workplace policies prohibiting unlawful manufacture, distribution, dispensing, possession, or use of controlled substances, and to communicate these policies to all employees engaged in providing the commodities or services under the bid.
Vendors must certify that they will inform employees of drug abuse dangers, implement the required workplace statement, ensure employees acknowledge the terms and notify the employer of any drug-related convictions within five days, and impose sanctions or require participation in rehabilitation programs for violating employees. The vendor's authorized representative must sign and date the form, certifying full compliance with all six specified requirements and committing to maintain a drug-free workplace in good faith throughout the contract term. This certification is a mandatory compliance document for bid submission and does not address pricing, set-asides, or other contract terms.
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| File | Type | Posted |
|---|---|---|
| 3-Substitute W9 Form.pdf.pdf | ||
| 5-ITB-26-00213 Rescue Disinfectant.pdf | ||
| 4-Direct Deposit Authorization Form 5.15.2025.pdf.pdf | ||
| 2-Insurance Certificate.doc | DOC document |
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Text version
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that
________________________________________________________ does:
(Name of Business)
1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition.
2. Inform employees about the dangers of drug abuse in the workplace, the business’ policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations.
3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 1893 or of any controlled substance law of the United States or any state, for violation occurring in the workplace no later than five (5) days after such conviction.
5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program, if such is available in the employee’s community, by any employee who is so convicted.
6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section.
As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements.
Offeror’s Signature
Date
DRUG-FREE WORKPLACE FORM
G:\Forms Library\0500-Forms\522_Drug Free Workplace Form.doc
File details come from the government source that posted it. Updated .