STD_21-_drug_free.pdf
PDF 58 KB Posted
- Attached to
- CFC CAREER PATHWAYS PROGRAM FISCAL AGENT
- Solicitation number
- 0000039632
- Issued by
- Sacramento County, San Francisco City, California
About this file
This is a State of California Drug-Free Workplace Certification form (STD. 21) required for contractors and grant recipients working with the state. The certification demonstrates compliance with California Government Code Section 8355 and applies to the CFC Career Pathways Program Fiscal Agent contract opportunity. Contractors must execute this certification prior to contract award, and the certificate remains valid for up to 36 months from the date executed, allowing the state to regard it as applicable to all contracts or grants entered into during that period without requiring individual certifications for each contract.
The certification obligates contractors to publish a statement prohibiting unlawful manufacture, distribution, dispensation, possession, or use of controlled substances; establish a Drug-Free Awareness Program informing employees of workplace drug dangers, company policy, available counseling and rehabilitation resources, and penalties for violations; and ensure every employee working on the contract receives the drug-free workplace policy statement and agrees to comply as a condition of employment. The form requires completion of contractor firm name, Federal ID number, authorized signature, date executed, signatory's printed name and title, telephone number, mailing address, and an optional expiration date not to exceed 36 months from execution. The certification is executed under penalty of perjury under California law.
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Other files
| File | Type | Posted |
|---|---|---|
| CCC_Fillable.pdf | ||
| STD._204_2021.pdf | ||
| CFC_Career_Pathways_Program_RFP_2026_RFP.pdf | ||
| Darfur.pdf | ||
| Bidder_Declaration.pdf |
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Text version
STATE OF CALIFORNIA
DRUG-FREE WORKPLACE CERTIFICATION
STD. 21 (Rev. 10/2019)
CERTIFICATION
I, the official named below, hereby swear that I am duly authorized legally to bind the contractor or grant recipient to the certification described below. I am fully aware that this certification, executed on the date below, is made under penalty of perjury under the laws of the State of California.
CONTRACTOR/BIDDER FIRM NAME FEDERAL ID NUMBER
BY(Authorized Signature)
DATE EXECUTED
PRINTED NAME AND TITLE OF PERSON SIGNING TELEPHONE NUMBER (Include Area Code)
TITLE
CONTRACTOR/BIDDER FIRM'S MAILING ADDRESS
The contractor or grant recipient named above hereby certifies compliance with Government Code Section 8355 in matters relating to providing a drug-free workplace. The above named contractor or grant recipient will:
1. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance is prohibited and specifying actions to be taken against employees for violations, as required by Government Code Section 8355(a).
2. Establish a Drug-Free Awareness Program as required by Government Code Section 8355(b), to inform employees about all of the following:
(a) The dangers of drug abuse in the workplace,
(b) The person's or organization's policy of maintaining a drug-free workplace,
(c) Any available counseling, rehabilitation and employee assistance programs, and
(d) Penalties that may be imposed upon employees for drug abuse violations.
3. Provide as required by Government Code Section 8355(c), that every employee who works on the proposed contract or grant:
(a) Will receive a copy of the company's drug-free workplace policy statement, and
(b) Will agree to abide by the terms of the company's statement as a condition of employment on the contract or grant.
4. At the election of the contractor or grantee, from and after the "Date Executed" and until
(DATE)
(NOT TO EXCEED 36 MONTHS), the state will regard this certificate as valid for all contracts or grants entered into between the contractor or grantee and this state agency without requiring the contractor or grantee to provide a new and individual certificate for each contract or grant. If the contractor or grantee elects to fill in the blank date, then the terms and conditions of this certificate shall have the same force, meaning, effect and enforceability as if a certificate were separately, specifically, and individually provided for each contract or grant between the contractor or grantee and this state agency.
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