10-99 e-verify compliance form pdf fill-in.pdf
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- Solicitation number
- Not on record
- Issued by
- Montgomery County, Pennsylvania
About this file
This is a Commonwealth of Pennsylvania Public Works Employment Verification Form completed for Montgomery Township in Montgomery County, Pennsylvania, relating to a contract for the supply and installation of front power take-off (PTO), front 3-point hitch, and an 11-foot or 12-foot plow for a John Deere 6120M tractor. The form certifies that the contractor or subcontractor is enrolled in the federal E-Verify Program and maintains compliance with Pennsylvania's Public Works Employment Verification Act. The sealed bid submission deadline is June 30, 2026 at 10:30 A.M., with bids to be opened and publicly read at Montgomery Township's offices located at 1001 Stump Road, Montgomeryville, PA 18936. All bid documents and solicitation details are available at no cost on PennBid (www.pennbid.net). The project scope includes transport of the tractor off-site, supply and installation of a LAFORGE PR5.5/6R front PTO and front 3-point hitch system, and a 3-point hitch mounted hydraulic angle snowplow, including required adapter kits and hardware integration, with transport of the completed tractor back to the Township.
A bid bond in the amount of 10 percent of the maximum bid amount is required at submission. The successful bidder must furnish Performance and Payment Bonds each in the amount of 100 percent of the contract amount. All bids remain subject to acceptance for sixty (60) days after bid opening or until a longer period agreed upon in writing. Bids may be withdrawn only within two (2) business days after bid opening in strict compliance with Pennsylvania law. This project is subject to the applicable provisions of Act 127, the Pennsylvania Public Works Employment Verification Act, as amended. A nominal PennBid fee of 0.33 percent of the bid amount (minimum $150 and maximum $6,000) is assessed only to awarded bidders. Montgomery Township reserves the right to reject any or all bids.
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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: Montgomery Township |
| ContractProject Number: N/A |
| Project Description: Supply and Installation of Front PTO, Front 3-Point Hitch, and 11-Foot or 12-Foot Plow for John Deere 6120M Tractor |
| Project Location: Montgomery Township, Montgomery County, PA |
| Printed Name: |
| Phone Number: |
| Email: |
| Today's Date: |
| Name of Authorized Representative: |
| MM/DD/YYYY: |
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