WV73 Drug Free Affidavit.pdf
PDF 83 KB Posted
- Attached to
- SHOWER REMODEL TO A SEAMLESS WALL SYSTEM
- Solicitation number
- ARFQ 0512 WSH2600000008 3
- Issued by
- Kanawha County, West Virginia
About this file
This is a Drug Free Workplace Conformance Affidavit required by the State of West Virginia for a shower remodel to a seamless wall system project. The affidavit mandates that bidders attest to maintaining a valid written drug-free workplace policy in compliance with West Virginia Code 21-1D. The document must be completed by an employee of the bidding company, notarized, and submitted with the bid submission. No specific project timeline, quantities, site visits, or bidder meetings are detailed in this form.
Submission of the completed affidavit is mandatory for bid compliance; failure to include it will result in automatic bid disqualification. The affidavit requires notarization and must be sworn under penalty of perjury. No pricing information, set-asides, funding sources, or contract terms are addressed in this conformance document, as it serves solely as a compliance verification tool for West Virginia's drug-free workplace requirements.
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Other files
| File | Type | Posted |
|---|---|---|
| Final_ARFQ_0512_WSH2600000008_2_WV_ARFQ_FORM.PDF | ||
| BondLaborMat.pdf | ||
| Addendum #1.pdf | ||
| Exhibit A - Pricing Page.xlsx | XLSX spreadsheet | |
| BondPerform.pdf | ||
| WV43-36.pdf | ||
| RFQ Specifications.docx | DOCX document | |
| Bid Bond Instructions.pdf | ||
| Addendum #2.pdf | ||
| Final_ARFQ_0512_WSH2600000008_1_WV_ARFQ_FORM.PDF | ||
| Final_ARFQ_0512_WSH2600000008_3_WV_ARFQ_FORM.PDF | ||
| OSAFederalFundsContractClauseAddendum.pdf | ||
| TCA.pdf | ||
| WV72 Drug Free Coversheet.pdf | ||
| Purchasing Affidavit.pdf | ||
| Bid Bond Form.pdf |
Show all 16
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Text version
State of West Virginia
DRUG FREE WORKPLACE CONFORMANCE AFFIDAVIT
West Virginia Code §21-1D-5
STATE OF WEST VIRGINIA,
COUNTY OF _______________, TO-WIT:
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 valid written drug free workplace policy and that such policy is in compliance with West Virginia Code §21-1D.
The above statements are sworn to under the penalty of perjury.
By: ______________________________________
Title: ______________________________________
Company Name: ________________________________
Date: ______________________________________
Taken, subscribed and sworn to before me this _____ day of ____________, _________.
By Commission expires _________________________
(Seal)
(Notary Public)
THIS AFFIDAVIT MUST BE SUBMITTED WITH THE BID IN ORDER TO COMPLY
WITH WV CODE PROVISIONS. FAILURE TO INCLUDE THE AFFIDAVIT WITH THE
BID SHALL RESULT IN DISQUALIFICATION OF THE BID.
Rev. August 2013
WV-73
Rev. 08/2013
| COUNTY OF: |
| I: |
| I am an employee of: |
| I do hereby attest that: |
| Title: |
| Company Name: |
| Date: |
| Taken subscribed and sworn to before me this: |
| day of: |
| undefined_2: |
| By Commission expires: |
File details come from the government source that posted it. Updated .