DrugFreeAff.pdf

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Attached to
Addendum 04 OSR Cheyenne Sales Company S-2009-96, O-11-83
Solicitation number
CRFQ 0313 DEP1600000014 5
Issued by
Taylor County, West Virginia

About this file

This is a Drug Free Workplace Conformance Affidavit required by the State of West Virginia pursuant to West Virginia Code 21-1D-5. The affidavit serves as a compliance document that must be submitted with bids to state and local contract opportunities. The document requires an authorized employee of the bidding company to attest under oath that the company maintains a valid written drug-free workplace policy in compliance with West Virginia Code 21-1D. The affidavit must be notarized and signed by a notary public. Failure to submit this completed affidavit with the bid will result in automatic disqualification of the bidder's proposal.

The affidavit is a mandatory compliance requirement with no pricing, set-aside provisions, or funding information associated with it. There are no specific response dates, due dates, or contract terms outlined in this document, as it functions solely as a conformance attestation that bidders must complete and include as part of their bid submission package. This requirement applies uniformly to all bidders and represents a precondition for bid acceptance rather than a substantive contract component.

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State of West Virginia

DRUG FREE WORKPLACE CONFORMANCE AFFIDAVIT

West Virginia Code §21-1D-5

STATE OF WEST VIRGINIA,

COUNTY OF _______________, TO-WIT:

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 valid written drug free workplace policy and that such policy is in compliance with West Virginia Code §21-1D.

The above statements are sworn to under the penalty of perjury.

By: ______________________________________

Title: ______________________________________

Company Name: ________________________________

Date: ______________________________________

Taken, subscribed and sworn to before me this _____ day of ____________, _________.

By Commission expires _________________________

(Seal)

(Notary Public)

THIS AFFIDAVIT MUST BE SUBMITTED WITH THE BID IN ORDER TO COMPLY

WITH WV CODE PROVISIONS. FAILURE TO INCLUDE THE AFFIDAVIT WITH THE

BID SHALL RESULT IN DISQUALIFICATION OF THE BID.

Rev. August 2013

WV-73

Rev. 08/2013

COUNTY OF:
I:
I am an employee of:
I do hereby attest that:
Title:
Company Name:
Date:
Taken subscribed and sworn to before me this:
day of:
undefined_2:
By Commission expires:

File details come from the government source that posted it. Updated .