ARFQ DCR27 6 Drug Free Affidavit.pdf

This is a Drug Free Workplace Conformance Affidavit form issued by the State of West Virginia in compliance with West Virginia Code 21-1D-5. The affidavit is executed by an employee on behalf of their employing company and certifies that the company maintains a written drug-free workplace policy in accordance with West Virginia Code 21-1D. The form requires the affiant to provide their printed name, signature, title, company name, and date of attestation. The affidavit must be notarized, with the notary public providing their printed name, title, date, county of residence, and commission expiration date.

This document serves as a mandatory compliance requirement for state and local contracts in West Virginia. Contractors and their designated employees are required to complete and submit this sworn affidavit as part of the bidding and contracting process. The form ensures that all contractors bidding on state and local government contracts maintain workplace drug policies that meet statutory requirements. There are no pricing terms, set-asides, or funding information contained in this compliance document, as it functions solely as a verification instrument for contractor eligibility and regulatory compliance prior to contract award.