ARFQ DEP2200000001 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 affidavit must be completed and notarized by an employee of the bidding company to attest that the organization maintains a written drug-free workplace policy in compliance with West Virginia Code 21-1D. The form requires the employee to provide printed name, signature, title, company name, and date of attestation. A notary public must witness and notarize the affidavit, including their printed name, title, commission expiration date, county, and signature.

This document serves as a compliance requirement for state and local contract opportunities in West Virginia and must be submitted as part of the bidding process. No pricing terms, contract amounts, or renewal options are specified in this form, as it functions solely as a certification document to verify that the contractor maintains workplace drug-free policies. The affidavit was approved on April 30, 2020, and the form was last revised on July 7, 2017.