DrugFreeAff.pdf

PDF 79 KB Posted

Attached to
TOWER DEMOLITION SERVICES
Solicitation number
ARFQ 0305 FOR2700000001 2
Issued by
Kanawha County, West Virginia

About this file

This is a Drug Free Workplace Conformance Affidavit form required by the State of West Virginia for the Tower Demolition Services contract opportunity. The document, approved as of April 30, 2020, serves as a sworn statement in compliance with West Virginia Code 21-1D-5, requiring company representatives to attest that their organization maintains a written drug-free workplace policy and plan that meets the requirements of West Virginia Code 21-1D. The affidavit must be completed by an employee of the bidding company and notarized before submission as part of the contract proposal process.

The affidavit requires the following information: employee name and title, company name, printed name of the signatory, signature, date of execution, notary public information including commission expiration date, and county of notarization. The document is sworn under penalty of perjury and serves as a compliance certification that must accompany bid submissions for state and local contract opportunities in West Virginia. No pricing, specific services, quantities, timelines, or award information is included in this conformance document, as it is solely a mandatory affidavit requirement.

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ARFQ FOR27-1 Addendum 1.pdf PDF
TCA.pdf PDF
BondPerform.pdf PDF
OneTimePurchaseRFQ - Radio Tower Demolition.docx DOCX document
Tower Pictures.pdf PDF
BondBidPrepInstruct.pdf PDF
WV72.pdf PDF
Final_ARFQ_0305_FOR2700000001_1_WV_ARFQ_FORM.PDF PDF
Final_ARFQ_0305_FOR2700000001_2_WV_ARFQ_FORM.PDF PDF

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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 .