Drug Free Workplace Affidavit.pdf

This is a Drug Free Workplace Conformance Affidavit form (WV-73) required by the State of West Virginia pursuant to West Virginia Code 21-1D-5. The affidavit serves as a compliance document for vendors and contractors doing business with the state. The form requires an authorized employee of the contracting company to attest under penalty of perjury that the company maintains a written drug-free workplace policy that complies with West Virginia Code 21-1D. The affidavit must be notarized and includes fields for the employee's printed name, signature, title, company name, and date of execution, as well as notary public certification including the notary's printed name, title, commission expiration date, and county of commission.

This document does not address pricing terms, set-asides, funding sources, or contract amounts. Rather, it functions as a mandatory compliance certification that bidders and contractors must complete and submit as part of the procurement process. The affidavit requirement ensures that all state contractors maintain drug-free workplace policies as mandated by West Virginia state law. No specific contract term, renewal options, or performance dates are identified within this form.