ARFQ DCR 2500000050 - Drug Free Affidavit.pdf

This is a Drug Free Workplace Conformance Affidavit form (WV-73) issued by the State of West Virginia in compliance with West Virginia Code 21-1D-5. The document serves as an attestation form that must be completed by an employee of a contracting company to certify that the organization maintains a written drug-free workplace policy compliant with state requirements. The form requires the affiant to identify themselves, their employer company, and their job title, and to swear under penalty of perjury that the named company has established and maintains a drug-free workplace plan meeting West Virginia Code 21-1D standards. The document must be notarized, with the notary public's commission expiration date included on the form.

This affidavit is a compliance and certification document rather than a procurement document with pricing, quantities, or delivery terms. It is a mandatory requirement for state and local contract opportunities in West Virginia and must be executed and sworn before a notary public. The form was approved and last revised on July 7, 2017. No pricing terms, set-asides, incumbent information, or funding details are contained within this document, as its sole purpose is to establish and document a contractor's adherence to West Virginia's drug-free workplace requirements as a condition of contract eligibility.