ARFQ DCR26_ 57- Drug Free Affidavit.pdf

This is a Drug Free Workplace Conformance Affidavit form required by the State of West Virginia under West Virginia Code 21-1D-5. The form serves as a sworn attestation that must be completed by an employee of a contracting company. The affidavit requires the employee to confirm that their employer maintains a written drug-free workplace policy that complies with West Virginia Code 21-1D. The document is notarized and executed under penalty of perjury, with sections for the employee's printed name, signature, title, company name, and date of execution. A notary public must witness the affidavit and provide their commission expiration date and official seal. The form version WV-73 was approved on April 30, 2020, with the most recent revision dated July 7, 2017.

This affidavit is a compliance requirement rather than a pricing or contract terms document. It establishes the mandatory drug-free workplace policy standard that must be met by any company or vendor seeking to contract with the State of West Virginia. The form does not contain pricing information, set-asides, funding amounts, or contract duration terms, as it functions solely as a certification mechanism to ensure workplace safety and legal compliance with state drug-free workplace statutes.