00 45 46 Public Works Employment Verification Form.pdf
PDF 129 KB Posted
- Attached to
- WCTA Meter Replacement Project
- Solicitation number
- US.257570
- Issued by
- Lancaster County, Pennsylvania
About this file
This is a Public Works Employment Verification Form issued by the Commonwealth of Pennsylvania for the WCTA Meter Replacement Project (Contract/Project Number 011364.0448) being undertaken by West Cocalico Township Authority. The form applies to contractors and subcontractors engaged in the project, which involves the replacement of approximately 790 water meters with new AMI (Advanced Metering Infrastructure) meters across West Cocalico Township. Bids for the construction project are being received online via PennBid until Thursday, November 5, 2026 at 10:00 AM local time, at which point bids will be opened and results posted for public review. Bid security in the form of a Certified Check or Bid Bond must be submitted with bids in an amount not less than 10 percent.
All contractors and subcontractors must complete and return this employment verification form to the contracting public body prior to contract award. The form requires certification of compliance with Pennsylvania's Public Works Employment Verification Act through enrollment and active utilization of the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. Contractors must verify the employment eligibility of all employees hired and maintain documentation confirming E-Verify usage for each new hire within five business days of the employee's start date throughout the duration of the public works contract. An authorized company representative must attest under penalty of law that all information contained in the verification form is true and correct.
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Text version
Street Address 2
City State Zip Code
Doing Business As:
(if different from Legal Name)
Commonwealth of Pennsylvania Public Works Employment Verification Form
Complete and return the form to the contracting Public Body prior to the award of the contract.
Company Legal Name: ___________________________________________________________
Mailing Address: ______________________________________________________
Check one: Contractor Subcontractor
Contracting Public Body: _________________________________________________________
Contract/Project Number: ________________________________________________________
Project Description: _____________________________________________________________
Project Location: _______________________________________________________________
Date Enrolled in E-Verify (MM/DD/YYYY): ___________________________________________ As a contractor/subcontractor for the above referenced public works contract, I hereby affirm that as of today’s date, __________________________, our company is in compliance with the Public Works Employment Verification Act (‘the Act’) through utilization of the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. To the best of my/our knowledge, all employees hired are authorized to work in the United States.
It is also agreed to that all public works contractors/subcontractors will utilize the federal EVP to verify the employment eligibility of each new hire within five (5) business days of the employee start date throughout the duration of the public works contract. Documentation confirming the use of the federal EVP upon each new hire shall be maintained in the event of an investigation or audit.
I,____________________________________________, authorized representative of the company above, attest that the information contained in this verification form is true and correct and understand that the submission of false or misleading information in connection with the above verification shall be subject to sanctions provided by law.
Authorized Representative Signature Date of Signature
Printed Name: _________________________________________________________________
Phone Number: ______________________ Email: ____________________________________
Street Address 1
Herbert, Rowland & Grubic, Inc. 00 45 46 - 1 011364.0448
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