Attachment A.docx

AFFIDAVIT

I certify to comply with the Drug-Free Workplace Act, Section 44-107-10.et.seq. of the South Carolina Code of Laws to provide a drug-free workplace (note: this clause applies to any resultant contract of $50,000 or more). The State of South Carolina has amended Title 44, Code of Laws of South Carolina, 1976, relating to health, by adding Chapter 107, so as to enact the Drug-Free Workplace Act.

Vendor: _______________________________________________________________________

Address: _______________________________________________________________________

Phone: _____________________ Fax___________________

FEIN/SSN: _____________________

Signature: ________________________________________

FAILURE TO FURNISH THE AFFIDAVIT WILL RESULT IN DELAY OF THE CONTRACT

THIS PAGE MUST BE SIGNED AND RETURNED TO:

South Carolina Vocational Rehabilitation Department Procurement Services 1410 Boston Avenue West Columbia SC 29170

Phone: 803-896-7556 Fax: 803-896-6538

Felicia W. Johnson, Commissioner

The South Carolina Vocational Rehabilitation Department prepares and assists eligible South Carolinians with disabilities to achieve and maintain competitive employment State Office ▪ 1410 Boston Avenue ▪ P.O. Box 15 ▪ West Columbia, South Carolina 29170-0015 ▪ scvrd.net 803-896-6500 (Office) ▪ 803-896-6553 (TTY) ▪ 800-832-7526 (Toll free) ▪ 803-896-6558 (Fax) ▪ info@scvrd.net image8.png image9.png image1.png image2.png image3.png image4.png image5.png image6.png image7.png