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.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| ARFQ FOR27-1 Addendum 1.pdf | ||
| TCA.pdf | ||
| BondPerform.pdf | ||
| OneTimePurchaseRFQ - Radio Tower Demolition.docx | DOCX document | |
| Tower Pictures.pdf | ||
| BondBidPrepInstruct.pdf | ||
| WV72.pdf | ||
| Final_ARFQ_0305_FOR2700000001_1_WV_ARFQ_FORM.PDF | ||
| Final_ARFQ_0305_FOR2700000001_2_WV_ARFQ_FORM.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 .