Drug Free Workplace 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 an attestation requirement for state and local contract opportunities in West Virginia. The affidavit requires an employee of the contracting company to formally swear under penalty of perjury that their employer maintains a written drug-free workplace policy compliant with West Virginia Code 21-1D. The form must be completed with the employee's printed name, signature, title, company name, and date of execution. The affidavit must be notarized, with the notary public providing their seal, printed name, title, date, county of commission, and commission expiration date.

This form is a mandatory compliance document rather than a solicitation with pricing or contractual terms. There are no pricing terms, set-asides, incumbent information, funding requirements, or renewal options specified in this affidavit. The document functions solely as a certification mechanism to ensure that companies bidding on or entering into state and local contracts in West Virginia meet the statutory drug-free workplace requirements. All bidders and contractors are expected to complete and submit this affidavit as part of their proposal or contract execution package.