DCR22-118 - Drug Free Affidavit.pdf

This is a Drug Free Workplace Conformance Affidavit form (WV-73) issued by the State of West Virginia in compliance with West Virginia Code 21-1D-5. The document serves as a sworn statement in which an employee of a company attests that their employer maintains a written drug-free workplace policy that conforms to West Virginia Code 21-1D requirements. The affidavit must be completed, signed by the employee, notarized, and submitted as part of state and local contract compliance documentation. The form requires the employee's printed name, signature, title, company name, and date, along with notarization by a commissioned notary public with their seal, printed name, title, and commission expiration date.

This affidavit form contains no pricing terms, set-asides, incumbent information, or funding requirements, as it is strictly a compliance certification document. The form approved on July 7, 2017, is a mandatory submission requirement for contractors seeking to do business with the State of West Virginia, ensuring adherence to drug-free workplace standards as outlined in state legislation. There are no renewal options, contract terms, or performance metrics associated with this standalone certification form.