ARFQ DEP2100000029 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 statement in which an employee attests that their employer maintains a written drug-free workplace policy in compliance with West Virginia Code 21-1D. The affidavit must be completed by a company employee, include the employee's printed name, signature, title, and the company name, and be notarized before a notary public. The form requires the notary to acknowledge the sworn statement with their seal, printed name, title, date, and commission expiration information.

This document is a mandatory compliance requirement for contractors and vendors doing business with the State of West Virginia. The affidavit form (WV-73) was approved as of April 30, 2020, and was last revised on July 7, 2017. There are no pricing terms, contract amounts, set-asides, or renewal options associated with this form, as it is solely a compliance certification document that must be submitted as part of the bidding or contracting process to demonstrate adherence to West Virginia's drug-free workplace standards.