ARFQ DEP1800000010 DRUG FREE AFFIDAVIT.pdf

92 KB Posted

Attached to
Vickers Branch (Richardson) Drainage - Addendum #1
Solicitation number
ARFQ 0313 DEP1800000010 2
Issued by
Logan County, West Virginia

About this file

Written by GovTribe AI ·

This is a Drug Free Workplace Conformance Affidavit form required by the State of West Virginia under West Virginia Code 21-1D-5 for contract bidding purposes. The affidavit requires an authorized employee of the bidding company to certify under oath that the company maintains a written drug-free workplace policy in compliance with West Virginia Code 21-1D. The form must be completed with the employee's printed name, signature, title, company name, and date, and must be notarized with the notary public's seal, signature, and commission expiration date. Submission of this completed and notarized affidavit is mandatory for bid compliance.

Failure to include the executed Drug Free Workplace Conformance Affidavit with a bid submission will result in automatic disqualification of that bid. The form is a standard requirement for all state and local contract opportunities in West Virginia and serves as proof of the bidding company's commitment to maintaining a drug-free workplace environment as mandated by state law. The affidavit form was last revised on August 1, 2015.

View the file

Other files

File Type Posted
ARFQ DEP1800000010 Vickers Branch (Richardson) Drainage TECHNICAL SPECS 5-8-17.pdf PDF
Final_ARFQ_0313_DEP1800000010_2_ARFQ_FORM.PDF PDF
ARFQ DEP1800000010 Addendum 1.pdf PDF
Final_ARFQ_0313_DEP1800000010_1_ARFQ_FORM.PDF PDF
ARFQ DEP1800000010 DEP Instructions to Bidders.pdf PDF
ARFQ DEP1800000010 DEP Construction Bid Submission Review Form.pdf PDF
ARFQ DEP1800000010 DEP STANDARD SPECIFICATIONS.pdf PDF
ARFQ DEP1800000010 DEP PROCUREMENT AFFIDAVIT.pdf PDF
ARFQ DEP1800000010 BID BOND FORM WITH INSTRUCTIONS.pdf PDF
ARFQ DEP1800000010 AVS FORM.pdf PDF
ARFQ DEP1800000010 VICKERS BRANCH PLANS.pdf PDF
Show all 11

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

State of West Virginia

DRUG FREE WORKPLACE CONFORMANCE AFFIDAVIT

West Virginia Code §21-1D-5

STATE OF WEST VIRGINIA,

COUNTY OF _______________, TO-WIT:

I, _______________________, after being first duly sworn, depose and state as follows:

1. I am an employee of _________________________________; and, (Company Name)

2. I do hereby attest that ____________________________________ (Company Name) maintains a written plan for a drug-free workplace policy and that such plan and policy are in compliance with West Virginia Code §21-1D.

The above statements are sworn to under the penalty of perjury.

Printed Name: ________________________________

Signature: ___________________________________

Title: ______________________________________

Company Name:________ _______________________

Date: ______________________________________

Taken, subscribed and sworn to before me this _____ day of ____________, _________.

By Commission expires _________________________

(Seal)

(Notary Public)

THIS AFFIDAVIT MUST BE SUBMITTED WITH THE BID IN ORDER TO COMPLY

WITH WV CODE PROVISIONS. FAILURE TO INCLUDE THE AFFIDAVIT WITH THE

BID SHALL RESULT IN DISQUALIFICATION OF THE BID.

Rev. August 1, 2015

WV-73

Approved / Revised 08/01/15

Printed Name:
Title:
Date:
County:
Vendor Name:
Company Name:
Company Name2:
day:
month:
year:
date of expiration:
Company Name3:

File details come from the government source that posted it. Updated .