00 45 46 Public Works Employment Verification Form.pdf
PDF 151 KB Posted
- Attached to
- West Pump Station Replacement Project
- Solicitation number
- Not on record
- Issued by
- Chester County, Pennsylvania
About this file
This is a Public Works Employment Verification Form required by the Commonwealth of Pennsylvania for contractors and subcontractors bidding on the West Pump Station Replacement Project for the Northwestern Chester County Municipal Authority. The form must be completed and submitted to the contracting public body prior to contract award. The West Pump Station Replacement Project involves construction of a new suction lift style pump station with building and site improvements to replace the existing facility, including demolition of the existing below-grade package pump station, construction of sanitary sewer piping and associated appurtenances, installation of new pumps, construction of force main piping, and general site improvements such as fencing, gate, and pavement. Bids for three separate contracts—General Construction (WPS-1), Electrical Construction (WPS-2), and Mechanical Construction (WPS-3)—will be received online until Wednesday, May 20, 2026 at 10:00 AM local time, at which point bids will be publicly opened and read. Bids shall be submitted on a lump sum basis for all contracts, with bidding documents available through https://pennbid.bonfirehub.com/.
As a condition of contract award, all contractors and subcontractors must verify compliance with the Public Works Employment Verification Act through enrollment in the federal E-Verify Program operated by the United States Department of Homeland Security. Contractors must attest that as of the enrollment date, all employees are authorized to work in the United States and must utilize E-Verify to verify employment eligibility of each new hire within five business days of the employee start date throughout the duration of the public works contract. Documentation confirming E-Verify usage must be maintained for investigation or audit purposes. The authorized representative must sign and date the form, certifying that all information provided is true and correct, with understanding that submission of false or misleading information is subject to legal sanctions.
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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 the above 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 000483.0450
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