00 45 46 Public Works Employment Verification Form.pdf
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- Solicitation number
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- Lancaster County, Pennsylvania
About this file
This is a Public Works Employment Verification Form issued by the Commonwealth of Pennsylvania for use by contractors and subcontractors on public works projects. The form requires contractors working on public works contracts to certify their enrollment in and compliance with the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. Contractors must complete and submit the form to the contracting public body prior to contract award, declaring the date of E-Verify enrollment and affirming that all employees hired are authorized to work in the United States. The form applies to both the 2025 Sanitary Sewer Improvements Project (Contract No. 2025-01) and the Sewer Maintenance & Emergency Contract (Contract 2026-01) with the Borough of Elizabethtown in Pennsylvania. Contractors must maintain documentation confirming E-Verify usage for each new hire within five business days of the employee start date throughout the duration of the public works contract and must be prepared to provide such documentation in the event of investigation or audit.
The form requires an authorized company representative to sign and attest that all information provided is true and accurate, with the understanding that submission of false or misleading information subjects the contractor to sanctions provided by law. The form requires basic company information including legal name, mailing address, doing business as name if applicable, and contact information for the authorized representative, including phone number and email address. This employment verification requirement is mandated under Pennsylvania's Public Works Employment Verification Act and applies as a condition of contract award for all public works projects in the Commonwealth.
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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 000598.0465
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