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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Other files
| File | Type | Posted |
|---|---|---|
| Final_ARFQ_0305_FOR2700000001_1_WV_ARFQ_FORM.PDF | ||
| Tower Pictures.pdf | ||
| WV72.pdf | ||
| BondBidPrepInstruct.pdf | ||
| BondPerform.pdf | ||
| TCA.pdf | ||
| 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 |
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File details come from the government source that posted it. Updated .