DRUG FREE WORKPLACE CONFORMANCE AFFIDAVIT.pdf
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- Solicitation number
- ARFQ-0512-MHC2500000001-1
- Issued by
- Marshall County, West Virginia
About this file
This document is a Drug Free Workplace Conformance Affidavit from the State of West Virginia. It requires the company submitting the affidavit to attest that they maintain a written plan for a drug-free workplace policy that is in compliance with West Virginia Code 21-1D. The affidavit must be signed and notarized. There are no details provided about a specific state or local contract opportunity.
The document does not contain information about products or services requested, project overviews, item quantities, response dates, due dates, site visits, bidder's meetings and conferences, award dates, the term of the contract, or any renewal options. Additionally, there is no information about pricing terms, set asides, incumbents, the current environment, funding requirements and sources, or any other salient details related to a contract opportunity.
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Text version
WV-73
Approved / April 30, 2020
State of West Virginia
DRUG FREE WORKPLACE CONFORMANCE AFFIDAVIT
West Virginia Code §21-1D-5
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:
STATE OF WEST VIRGINIA,
COUNTY OF ____________________________, TO-WIT:
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 .