1-Public Works Employment Verification Form.pdf
PDF 125 KB Posted
- Attached to
- Spyglass Hill Road Stormwater Basins 1 & 2 Retrofit and Broad Street Rain Garden, Contract No. 26-01
- Solicitation number
- Not on record
- Issued by
- Northampton County, Pennsylvania
About this file
This is a Public Works Employment Verification Form required by the Commonwealth of Pennsylvania for contractors and subcontractors on public works projects, specifically applicable to the Spyglass Hill Road Stormwater Basins 1 & 2 Retrofit and Broad Street Rain Garden project (Contract No. 26-01) being conducted by Bath Borough Stormwater Authority. The form must be completed and returned to the contracting public body prior to contract award. The project involves retrofitting two existing detention basins in the Holiday Hills Subdivision along Spyglass Hill Road into modern infiltration basins with modifications to outlet structures and replacement of perimeter fencing and gates, as well as construction of a rain garden within a stormwater easement on Northampton Area School District property. Sealed bids are due by 12:00 Noon on Friday, May 22, 2026, with a mandatory pre-bid meeting scheduled for 10:00 AM on Tuesday, May 12, 2026, at the Bath Borough Municipal Building located at 121 South Walnut Street, Bath, PA 18014. Colliers Engineering & Design serves as the professional consultant responsible for the project.
The form requires all contractors and subcontractors to affirm compliance with the Public Works Employment Verification Act through enrollment and utilization of the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. Contractors must verify the employment eligibility of each new hire within five business days of the employee start date and maintain documentation of such verification throughout the duration of the public works contract. Bid security must be submitted in the amount of at least ten percent of the bidder's maximum bid price in the form of a certified check. The form requires completion of company information, project details, date of E-Verify enrollment, and attestation by an authorized representative, with submission subject to sanctions for false or misleading information.
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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
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