DRUG FREE WORKPLACE CONFORMANCE AFFIDAVIT.pdf
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- Solicitation number
- ARFQ-0512-MHC2500000001-3
- Issued by
- Marshall County, West Virginia
About this file
This document is a Drug Free Workplace Conformance Affidavit from the State of West Virginia. The affidavit requires the company named to attest that they maintain a written plan for a drug-free workplace policy in compliance with West Virginia Code 21-1D. The affidavit must be signed, notarized, and submitted as part of the contracting process with the State of West Virginia.
The document does not provide any details on a specific contract opportunity. It is simply a standard affidavit required as part of the State of West Virginia's contracting procedures to ensure contractors maintain a drug-free workplace.
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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 .