1-Public Works Verification.pdf
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- Erie County, Pennsylvania
About this file
This is a Public Works Employment Verification Form from the Commonwealth of Pennsylvania, applicable to the City of Erie's procurement activities and related construction projects. The form functions as a compliance document that contractors and subcontractors must complete and submit to the contracting public body prior to contract award. The form requires contractors to provide company legal name, business address, project identification information, and the date of enrollment in the federal E-Verify program. By completing this form, contractors affirm compliance with Pennsylvania's Public Works Employment Verification Act and certify that all employees hired are authorized to work in the United States through utilization of the federal E-Verify Program operated by the U.S. Department of Homeland Security.
The form establishes a mandatory verification requirement for all public works contractors and subcontractors working on City of Erie projects, including the referenced milling and asphalt resurfacing project (Bid #1846-26) and other municipal construction initiatives. This verification mechanism ensures workforce eligibility compliance across all City of Erie public works contracts and must be completed prior to contract execution. There are no pricing terms, set-asides, or funding sources specified within this verification document, as it serves solely as an employment eligibility attestation requirement separate from the bidding and contract award processes.
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Text version
Commonwealt h of Pennsylvania
Public Works Em p loyment Verification Form Complete a.nd retJJ.m the form to the contracttng Publlc Body prior to the award of the contract.
Company Le-gal Name: ___________________________ _
Doing Business As: ____________________________ _ (if OJjferent from Lego/ Nome}
Mail ing Addre:ss:
0,edcone:
StTfft Address 1
Suftt Address l
City
0 Contractor
State, 0 Subcontractor
Zip Code, Contracting Public Body: __________________________ _
Contract/Project N:umber: __________________________ _
Project Description: ____________________________ _
Project LDcatlon: _____________________________ _
Date Enrolled In E-Vecrl fy (MM/OD/YYYY): __________________ _
As a contractor/suboontractor for the above referenced publ ic 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 utill2atlon of the federal E•Verlfy Program {EVP) ope.rated by the Unit ed States Department of Homeland Security. To the best of my/our knowledge, all employees hired are authorized t o work In the United States.
It Is also agreed to that all public works contract·ocs/subcontractO<S will utilize the federal EVP t o verify the employment ellglblllty of each new hire w'rthln five (S) business days of the employee start date throughout the duration of the publk 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, ____________________ ~ aut.hortzed representative of the company above, attest that the Information contained In th.ls verification form Is t rue and correct and understand ttiat the submission of false or mlsle.adln_g Information In connection wfth the above verification shall be S-tJbject to sanctions provided by law.
Author ized Representative Sfgnature
Printed Name:
Date of Signature
Phone Number: ___________ Email: ________________ _
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