ARFQ DCR27 6 Drug Free 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. The form serves as a sworn attestation document for employees of companies contracting with the state. The affiant must confirm that their employing company maintains a written drug-free workplace policy and plan that complies with West Virginia Code 21-1D. The document requires completion with the employee's printed name, signature, title, company name, and date of execution. The affidavit must be notarized before a notary public, including the notary's printed name, title, date, county of commission, and commission expiration date.

This affidavit is a compliance document rather than a solicitation or contract vehicle. It represents a mandatory requirement for state contractors and their employees as part of West Virginia's drug-free workplace initiative. The form was approved on April 30, 2020, with the most recent revision dated July 7, 2017. No pricing, set-asides, incumbent information, funding sources, or contract terms are contained within this document, as it functions solely as a certification mechanism to verify adherence to state workplace drug policy requirements.