00 45 46 Public Works Employment Verification Form.pdf
PDF 155 KB Posted
- Attached to
- 2027 Sewer System Improvements Project
- Solicitation number
- Not on record
- Issued by
- Dauphin County, Harveys Lake Borough, 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 completion and submission to the contracting public body prior to contract award and applies to the 2027 Sewer System Improvements Project managed by Capital Region Water (CRW) in Harrisburg, Pennsylvania. The form documents a company's enrollment in the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security and certifies compliance with Pennsylvania's Public Works Employment Verification Act. Contractors and subcontractors must verify the employment eligibility of all new hires within five business days of the employee start date throughout the duration of the public works contract and maintain documentation of E-Verify usage for investigation or audit purposes. The form requires completion of company information including legal name, mailing address, contractor or subcontractor designation, contract/project number, project description, project location, and the date of E-Verify enrollment.
The authorized representative of the company must attest under penalty of law that all information contained in the verification form is true and correct, with submission of false or misleading information subject to legal sanctions. The form requires the signature, printed name, phone number, and email address of the authorized representative along with the date of signature. This verification requirement applies to all contractors and subcontractors working on public works projects within Pennsylvania and is a prerequisite for contract award, ensuring compliance with state employment verification mandates and federal immigration law enforcement procedures.
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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 rbowshot Typewriter Herbert, Rowland & Grubic, Inc. 00 45 46 - 1 004379.0510
| Company Legal Name: |
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| Contractor: Off |
| Subcontractor: Off |
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| Date Enrolled in EVerify MMDDYYYY: |
| I: |
| Printed Name: |
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File details come from the government source that posted it. Updated .