DrugFreeAff.pdf

PDF 79 KB Posted

Attached to
TOWER DEMOLITION SERVICES
Solicitation number
ARFQ 0305 FOR2700000001 1
Issued by
Kanawha County, West Virginia

About this file

This is a Drug Free Workplace Conformance Affidavit required by the State of West Virginia for the Tower Demolition Services contract opportunity. The document serves as a sworn attestation form that must be completed by an authorized employee of any bidding contractor to certify compliance with West Virginia Code 21-1D-5 regarding drug-free workplace policies. The affidavit requires the signatory to confirm under penalty of perjury that the company maintains a written drug-free workplace plan that is in full compliance with the applicable West Virginia statute. The form must be notarized before a Notary Public, with the notary's commission expiration date and seal affixed to validate the sworn statement.

The affidavit does not contain specific pricing terms, set-asides, funding amounts, or contract performance details. Instead, it functions as a compliance certification document that bidders must submit as part of their proposal package. The form establishes a prerequisite qualification requirement for any contractor seeking to work on this State of West Virginia project, ensuring that all awarded contractors maintain drug-free workplace standards as mandated by state law.

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OneTimePurchaseRFQ - Radio Tower Demolition.docx DOCX document

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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

DrugFreeAff.pdf
State ofWest VirginiaDRUG FREEWORKPLACECONFORMANCE AFFIDAVIT
Printed Name:
Title:
Date:
COUNTY OF:
By Commission expires:
Day:
Month:
Year:
Name:
Company Name:
Company Name2:

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