1-Public Works Employment Verification Form.pdf
PDF 125 KB Posted
- Attached to
- 2026 Street Rehab Project
- Solicitation number
- Not on record
- Issued by
- Cumberland County, Pennsylvania
About this file
This is a Public Works Employment Verification Form used by the Commonwealth of Pennsylvania for contractors and subcontractors bidding on public works contracts, specifically applicable to the 2026 Street Rehab Project solicited by Wormleysburg Borough. The form requires contractors to affirm 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 complete and return the form to the contracting public body prior to contract award. The form captures essential company information including legal name, mailing address, project details, and the date of E-Verify enrollment. Bidders for the 2026 Street Rehab Project must submit sealed bids online through PennBID by Wednesday, July 8, 2026, at 2:00 PM local time. The project scope includes milling, 330 tons of wearing/leveling course, drainage pipe replacement, curb ramp replacement, and other specified work. A certified check or bid bond representing ten percent of the total bid, issued by a surety licensed in Pennsylvania, is required with bid submission.
The contractor must commit to utilizing E-Verify to verify employment eligibility of all new hires within five business days of the employee start date throughout the contract duration and maintain documentation confirming such verification for potential investigations or audits. All documentation supporting E-Verify compliance must be preserved. The contract is subject to multiple regulatory requirements including the Pennsylvania Prevailing Wage Act, Federal Occupational Safety and Health Act (OSHA), Pennsylvania Act 229 of 2002, the Pennsylvania One Call Act, Pennsylvania Human Relations Act 222 Conditions, non-discrimination in employment and contract compliance regulations, and non-collusion affidavit requirements. Questions regarding the project must be submitted online via PennBID no later than 4:00 PM on Monday, July 6, 2026. Wormleysburg Borough reserves the right to accept or reject any or all bids submitted.
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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
| Company Legal Name: |
| Doing Business As: |
| Street Address 1: |
| Street Address 2: |
| City: |
| State: |
| Zip Code: |
| Contractor: Off |
| Subcontractor: Off |
| Contracting Public Body: |
| ContractProject Number: |
| Project Description: |
| Project Location: |
| Printed Name: |
| Phone Number: |
| Email: |
| Today's Date: |
| Name of Authorized Representative: |
| MM/DD/YYYY: |
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