Drug Free Workplace Affidavit.pdf

This is a Drug Free Workplace Conformance Affidavit form issued by the State of West Virginia pursuant to West Virginia Code 21-1D-5. The document serves as an attestation that a company maintains a written drug-free workplace policy in compliance with West Virginia Code 21-1D. The affidavit requires completion by a company employee who must swear under penalty of perjury that the specified company has established and maintains such a policy. The form requires the deponent to provide their name, title, company affiliation, and signature, along with notarization by a public notary including the notary's printed name, title, commission expiration date, and seal. The document includes fields for multiple company names if applicable.

This is a mandatory compliance document rather than a procurement with pricing or contractual terms. Submission of this affidavit is a requirement for doing business with the State of West Virginia and demonstrates the contractor's commitment to maintaining drug-free workplace standards. No pricing information, set-asides, incumbency status, funding amounts, or renewal options are applicable to this document, as it functions solely as a certification of policy compliance and workforce safety standards.