5-TOH-320 - Drug-Free Workplace Compliance Form - 4.1.24.pdf
PDF 112 KB Posted
- Attached to
- Capital Improvement Funding
- Solicitation number
- RFLC-26-001
- Issued by
- Osceola County, Florida
About this file
This is a Drug-Free Workplace Compliance Form issued by the Tohopekaliga Water Authority in Florida, required for vendors seeking to engage in business with the Authority. The form mandates that contractors certify compliance with the Drug-Free Workplace Act of 1988 (41 U.S.C. 8101 et seq.) and commit to implementing a comprehensive drug-free workplace program. Vendors must publish workplace drug prohibition statements, inform employees about drug abuse dangers and available counseling resources, distribute compliance statements to all employees engaged in contract work, require employees to report drug-related convictions within five days, and impose sanctions or require participation in rehabilitation programs for violations. The form requires submission with the bid as a condition of contract eligibility and must be executed by an authorized representative under penalty of perjury.
The form requires notarization before a notary public, with the signatory confirming personal knowledge, legal authority to bind the vendor, and understanding of the certification requirements. The undersigned must be at least 18 years old and competent to execute the certification. The form applies to all vendors bidding on Capital Improvement Funding opportunities with the Tohopekaliga Water Authority and serves as a contractual obligation to maintain drug-free workplace standards throughout the term of any awarded contract. No specific pricing, set-asides, or contract term information is detailed in this compliance form, as it functions as a mandatory prerequisite certification document rather than a solicitation document itself.
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Text version
FORM
TOH-320
v: 04/2024
Drug-Free Workplace Compliance Form Form Page
Instructions: “Vendor(s)”, defined as person or entity seeking to engage in business with the Tohopekaliga Water Authority (“Toho”), must use this form to certify that they will take the requisite “affirmative steps” as discussed below. The terms “Contract” and “Agreement” may be interchangeably used.
Vendor Name (as on Sunbiz.org):
Solicitation/Contract Number:
Drug-Free Workplace Compliance Form
Contractor shall comply with all provisions of the Drug-Free Work Place Act of 1988, 41 U.S.C. §8101 et seq., as amended. The Contractor shall commit to comply with this requirement by completing this form and submitting it with its Bid. In order to have a drug-free workplace program, Contractor certifies that it will:
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’s 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 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than 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 the Project.
Vendor’s Initials: _______
FORM
TOH-320
v: 04/2024
Drug-Free Workplace Compliance Form Form Page
EXECUTION OF ABOVE CERTIFICATION
The undersigned hereby represents that they: make the above certification based upon personal knowledge; are over the age of 18 years and otherwise competent to make the above certification; and are authorized to legally bind and make the above certification on behalf of the Vendor.
Under penalties of perjury, the undersigned declares that they have read and understand the contents of the foregoing form. Pursuant to the authority granted to the undersigned by Vendor, the undersigned hereby acknowledges, affirms, and makes the certification provided above on behalf of Vendor.
By:
Authorized Representative on behalf of Vendor
Printed Name:
Official Title:
STATE OF _________________
COUNTY OF _______________
The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this ____ day of ________________________, 20____, by _______________________, as
__________________ of __________________________, a ________________________________ authorized to do business in the State of Florida on behalf of the company/corporation. They ☐ are personally known to me or ☐ have produced ___________________________ as identification.
(Seal)
Signature of Notary Public
Name of Notary Typed, Printed or Stamped
File details come from the government source that posted it. Updated .