WV73 Drug Free Affidavit.pdf
PDF 83 KB Posted
- Attached to
- CHILLER AND VENTILATION MAINTENANCE
- Solicitation number
- ARFQ 0512 WSH2700000006 1
- 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 Chiller and Ventilation Maintenance contract opportunity. The affidavit is mandated under West Virginia Code 21-1D-5 and must be completed and notarized by a company employee to certify that the bidding company maintains a valid written drug-free workplace policy in compliance with West Virginia Code 21-1D. The affidavit requires the employee to provide their name, title, company name, and date, and must be sworn before a notary public. Submission of this completed affidavit with the bid is a mandatory compliance requirement; failure to include it will result in automatic disqualification of the bid.
The form is standardized for West Virginia state and local contracts and contains no specific pricing terms, set-asides, contract duration, or project-specific details. The affidavit serves solely as a prerequisite certification document establishing the bidder's commitment to maintaining a drug-free workplace environment as a condition of bid eligibility.
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Other files
| File | Type | Posted |
|---|---|---|
| TCA.pdf | ||
| Exhibit B.xlsx | XLSX spreadsheet | |
| WV75 - Construction Bid Submission Review.pdf | ||
| WV36.pdf | ||
| WV43.pdf | ||
| RFQ Specifications.docx | DOCX document | |
| Exhibit C.xlsx | XLSX spreadsheet | |
| Bid Bond Form.pdf | ||
| Final_ARFQ_0512_WSH2700000006_1_WV_ARFQ_FORM.PDF | ||
| Bid Bond Instructions.pdf | ||
| BondPerform.pdf | ||
| Purchasing Affidavit.pdf | ||
| BondLaborMat.pdf | ||
| Exhibit A.docx | DOCX document | |
| WV72 Drug Free Coversheet.pdf | ||
| OSAFederalFundsContractClauseAddendum.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 .