Exhibit M - State of WV Drug Free Affidavit.pdf

77 KB Posted

Attached to
PSC - Church McKee Arts Center Stage Rigging
Solicitation number
RFP202690000659
Issued by
Mingo County, West Virginia

About this file

Written by GovTribe AI ·

This document is a Drug Free Workplace Conformance Affidavit from the State of West Virginia, specifically related to West Virginia Code §21-1D-5. The form requires an employee of a company to attest that their organization maintains a written plan for a drug-free workplace policy that complies with the specified state legal code.

The affidavit is a standardized form (WV-73) approved on April 30, 2020, with a revision date of July 7, 2017. It is designed to be completed and sworn before a notary public, with spaces for the individual's printed name, signature, title, company name, and date. The document requires the signatory to declare under penalty of perjury that their company has a documented drug-free workplace policy meeting West Virginia's legal requirements.

View the file

Other files

File Type Posted
Exhibit G - Hanging Plot.pdf PDF
Exhibit H - ANSI E1.4-1-2022 Manual Counterweight Rigging Systems.pdf PDF
Exhibit E - Pictures.pdf PDF
1333225-event.pdf PDF
Exhibit C - Similar Project Experience.pdf PDF
Exhibit N - Purchasing Affidavit.pdf PDF
Exhibit B - Cost Summary.xlsx XLSX spreadsheet
Exhibit J - PSC Campus Map.pdf PDF
RFP202690000659.pdf PDF
Exhibit K - State of WV & WVU Requirements.pdf PDF
Contractor Safety Requirements November 2019.pdf PDF
Exhibit F - Inspection Report.pdf PDF
Exhibit A - Scope of Services.pdf PDF
Exhibit L - Safety Evaluation.pdf PDF
Exhibit O - CD200 Example.pdf PDF
Exhibit D - Architectural and Structural Drawings.pdf PDF
Exhibit I - Counterweight Inventory.pdf PDF
Show all 17

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

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

Name:
Company Name2:
Printed Name:
Title:
Company Name:
Date:
COUNTY OF:
Day:
Month:
Year:
By Commission expires:

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