Drug Free Affidavit.pdf
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- Solicitation number
- ARFQ-0608-DCR2500000049-1
- Issued by
- Upshur County, West Virginia
About this file
This document is a Drug-Free Workplace Conformance Affidavit for the State of West Virginia. It requires the company named to attest that it maintains a written plan for a drug-free workplace policy that is in compliance with West Virginia Code 21-1D. The affidavit must be signed by an authorized employee of the company and notarized. This affidavit appears to be a required submission for a state or local contract opportunity in West Virginia.
The document does not provide any details about the specific contract opportunity, such as the products or services requested, project overviews, response dates, award dates, or contract term. It solely focuses on the requirements for the drug-free workplace affidavit.
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Text version
WV-73
Approved / July 7, 2017
State of West Virginia
DRUG FREE WORKPLACE CONFORMANCE AFFIDAVIT
West Virginia Code §21-1D-5
STATE OF WEST VIRGINIA,
COUNTY OF , TO-WIT:
I, , after being first duly sworn, depose and state as follows:
1. I am an employee of ; and, (Company Name)
2. I do hereby attest that
(Company Name) maintains a written plan for a drug-free workplace policy and that such plan and policy are in compliance with West Virginia Code §21-1D.
The above statements are sworn to under the penalty of perjury.
Printed Name:
Signature:
Title:
Company Name:
Date:
Taken, subscribed and sworn to before me this day of , .
By Commission expires
(Seal)
(Notary Public)
Rev. July 7, 2017
File details come from the government source that posted it. Updated .