11-5. Supporting Documents 5 Public Works Employment Verification Form.pdf
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- Solicitation number
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- Delaware County, Pennsylvania
About this file
This is a Public Works Employment Verification Form required by the Commonwealth of Pennsylvania for contractors and subcontractors working on public works projects in the state. The form applies to the City of Chester, Pennsylvania's procurement opportunities, including the Chester Police Station 3rd Floor Interior Renovations project, which involves approximately 1,500 square feet of renovation work including demolition, drywall installation, carpeting, lighting, painting, and related improvements. The form must be completed and submitted to the contracting public body prior to contract award. Bidders are required to confirm their enrollment in the federal E-Verify Program operated by the United States Department of Homeland Security and affirm compliance with the Public Works Employment Verification Act. Contractors and subcontractors 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 duration of the public works contract and maintain documentation of E-Verify usage for investigation or audit purposes.
The form requires an authorized company representative to attest under penalty of law that all information provided is true and correct, with false or misleading information subject to legal sanctions. Contractors must provide company legal name, mailing address, contact information, project details, and the date of E-Verify enrollment. Pennsylvania Prevailing Wage Project Rates apply to the Chester Police Station renovation project. This employment verification requirement applies to all contractors and subcontractors bidding on public works projects within Pennsylvania, ensuring workforce compliance and authorization to work in the United States.
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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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