Attachment 10 Drug Free - Fillable Form.pdf
PDF 1 MB Posted
- Solicitation number
- IFB-MKAA-0000000003
- Issued by
- Bradley County, Tennessee
About this file
The document is a Drug Free Workplace Affidavit for the Metropolitan Knoxville Airport Authority (DKX) related to the Reroof Museum Hangar and Reroof of Maintenance Building project in Tennessee. The affidavit is required pursuant to T.C.A. Section 50-9-113 for employers with five or more employees who contract with state or local government to provide construction services. The form requires the company to affirm that they have a drug-free workplace program that complies with Title 50, Chapter 9 of the Tennessee Code Annotated.
This standardized affidavit must be completed and notarized by a principal officer of the company, declaring compliance with state regulations regarding drug-free workplace policies. The document is part of the bid documentation for the DKX project, which involves roofing work for a museum hangar and maintenance building, and serves as a mandatory submission to demonstrate the contractor's commitment to maintaining a safe and drug-free work environment as a condition of bidding on the contract.
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Text version
MCGHEE TYSON AIRPORT TERMINAL APRON EXPANSION
ALCOA, TENNESSEE ISSUED FOR BID – SEPTEMBER 30, 2022
DRUG FREE WORKPLACE AFFIDAVIT BF-43
DRUG FREE WORKPLACE AFFIDAVIT
STATE OF _____________________________
COUNTY OF___________________________
____________________________________ being first duly sworn, deposes and says as follows:
1. The undersigned is a principal officer of ___________________________ hereinafter referred to as the “Company”, and is duly authorized to execute this Affidavit on behalf of the Company.
2. The Company submits this Affidavit pursuant to T.C.A. Section 50-9-113, which requires each employer with no less than five (5) employees receiving pay who contracts with the state or any local government to provide construction services to submit an affidavit stating that such employer has a drug free workplace program that complies with Title 50, Chapter 9 of the Tennessee Code Annotated.
3. The company is in compliance with T.C.A. Section 50-9-113.
Further affiant saith not.
Principal Officer
STATE OF____________________________________________
COUNTY OF__________________________________________
Before me personally appeared _________________________________________________, with whom I am personally acquainted (or proved to me on the basis of satisfactory evidence) and who acknowledged that he/she is the _____________________ of the Company a _________________________ and that he/she, being authorized so to do, executed this affidavit for the purposes therein contained, by signing the name of the Company by himself/herself as
Witness my hand and seal at office this ______day of _____________________20______, Notary Public
My Commission Expires______________________________
Kalousek, John Rectangle
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Text Box Attachment No. 10
Text Box Attachment No. 10
MCGHEE TYSON AIRPORT TERMINAL APRON EXPANSION
ALCOA, TENNESSEE ISSUED FOR BID – SEPTEMBER 30, 2022
INTENTIONALLY LEFT BLANK
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| 1. The undersigned is a principal officer of ___________________________ hereinafter referred to as the “Company”, and is duly authorized to execute this Affidavit on behalf of the Company. |
| 2. The Company submits this Affidavit pursuant to T.C.A. Section 50-9-113, which requires each employer with no less than five (5) employees receiving pay who contracts with the state or any local government to provide construction services to submit ... |
| 3. The company is in compliance with T.C.A. Section 50-9-113. |
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