11-PWVF-1 4.24.2026.pdf
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- Attached to
- Wysox Community Park Boat Launch Project
- Solicitation number
- Not on record
- Issued by
- Blair County, Pennsylvania
About this file
This is a Public Works Employment Verification Form issued by the Commonwealth of Pennsylvania for use by contractors and subcontractors on public works projects, specifically the Wysox Community Park Boat Launch Project in Wysox Township, Pennsylvania. The form confirms contractor compliance with the Public Works Employment Verification Act through participation in the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. Sealed bids for the Wysox Community Park Boat Launch Project are due electronically via the PennBid Program by July 31, 2026, at 3:00 pm, with bid opening scheduled for approximately 3:30 pm the same day at the offices of Woodland Design Associates, Inc., 119 Lincoln Street, Honesdale, PA 18431. The project scope includes mobilization and site staging; installation of temporary erosion and sediment control measures; demolition and site preparation; installation of a coffer dam bypass system; construction of a cast-in-place concrete boat launch; preparation and paving of drives and parking areas; and installation of grass medians, among other work items as specified in the project plans and specifications.
All contractors and subcontractors hired for this public works contract must utilize the federal E-Verify Program to confirm employment eligibility of each new hire within five business days of the employee start date throughout the contract duration. Contractors must maintain documentation confirming E-Verify usage for all new hires in the event of investigation or audit. By submitting the verification form, the authorized company representative attests under penalty of law that all employees hired after January 1, 2013, are authorized to work in the United States and that the information provided is true and correct. Submission of false or misleading information subjects the contractor to sanctions provided by law.
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Text version
COMMONWEALTH OF PENNSYLVANIA
PUBLIC WORKS EMPLOYMENT VERIFICATION FORM
Date _______________________
Business or Organization Name (Employer)_________________________________________________
Address _____________________________________________________________________________
City _____________________________________ State_____________ Zip Code ________________
Contractor {dzōŎƻƴǘNJŀŎǘƻNJ όŎƘŜŎƪ ƻƴŜύ
Contracting Public Body _______________________________________________________________
Contract/Project No ___________________________________________________________________
Project Description ____________________________________________________________________
Project Location ______________________________________________________________________
As a contractor/subcontractor for the above referenced public works contract, I hereby affirm that as of the above 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 post
January 1, 2013 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: |
| Address: |
| City: |
| State: |
| Zip Code: |
| Contracting Public Body: |
| ContractProject No: |
| Project Description: |
| Project Location: |
| Name: |
| Business or Organization Name - Employer: |
| Signature: |
| Check Box1: Off |
| Check Box2: Off |
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