STD_21-_drug_free.pdf
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- Solicitation number
- 0000040460
- Issued by
- California
About this file
This is a Drug-Free Workplace Certification form (STD. 21) issued by the State of California, applicable to all state contractors and grant recipients. The certification requires contractors to comply with Government Code Section 8355 by implementing comprehensive drug-free workplace policies and programs. Contractors must publish statements prohibiting unlawful manufacture, distribution, dispensation, possession, or use of controlled substances; establish a Drug-Free Awareness Program informing employees about workplace drug abuse dangers, company policies, available counseling and rehabilitation resources, and penalties for violations; and ensure all employees working on state contracts or grants receive and agree to abide by the company's drug-free workplace policy statement as a condition of employment. The form requires an authorized company representative to execute the certification under penalty of perjury, providing the contractor firm name, federal ID number, authorized signature, execution date, signatory's printed name and title, telephone number, and mailing address.
At the contractor's election, the certification remains valid for all contracts or grants entered into between the contractor and the state agency for up to 36 months from the execution date, eliminating the need to provide individual certificates for each subsequent contract or grant during that period. This single certification applies across multiple state transactions if the contractor elects to specify an expiration date not exceeding 36 months from execution. The form has been verified for accessibility compliance with no structural or technical issues identified.
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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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Summary Skipped Tables must have a summary
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