ARFQ DEP22-063 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, applicable to state and local contract opportunities in West Virginia. The affidavit serves as a compliance document through which an employee, acting on behalf of their company, attests that their employer maintains a written drug-free workplace policy in accordance with West Virginia Code 21-1D. The form requires the employee to provide their name, title, company name, and signature, along with notarization by a public notary who must also sign and provide their commission expiration date. The document includes fields for the county location and allows for multiple company names to be listed if applicable.

This affidavit is a mandatory submission requirement for contractors and vendors seeking to do business with West Virginia state and local government entities. Contractors must complete and submit the notarized affidavit as part of their bid or proposal package to demonstrate compliance with the state's drug-free workplace requirements. No pricing, set-asides, award dates, or contract terms are specified within this form, as it functions solely as a certification document confirming the contractor's adherence to established drug-free workplace policies rather than as a substantive contract document.