ARFQ DCR23-156 - Drug Free Workplace Affidavit.pdf

This is a Drug Free Workplace Conformance Affidavit form (WV-73) required by the State of West Virginia under West Virginia Code 21-1D-5 for contract opportunity ARFQ DCR23-156. The affidavit serves as a certification document that must be completed and sworn by an authorized employee of a contracting company. The form requires the employee to attest that their company maintains a written drug-free workplace policy in compliance with West Virginia Code 21-1D. The affidavit must be notarized and includes fields for the employee's printed name, signature, title, company name, and date of execution, as well as notary public information including commission expiration date.

This document represents a compliance requirement rather than a pricing or service delivery instrument. All bidding entities must complete and submit this affidavit as part of their proposal package to demonstrate adherence to West Virginia's drug-free workplace statutory requirements. The affidavit carries legal weight as statements made under penalty of perjury, making it a mandatory certification that contractors must provide prior to contract award.