17-Doc 00 73 00 5 - Appendix B - Public Works Employment Verification Form.pdf
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- Attached to
- 2500999 - Canterbury Storm Sewer Replacement State and local contract opportunity
- Solicitation number
- Not on record
- Issued by
- Montgomery County, Mount Aetna CDP, 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 within Montgomery Township, Montgomery County. The form pertains to Contract 2500999, the Canterbury Storm Sewer Replacement Project, which involves the removal and replacement of approximately 1,800 feet of corroded storm sewer piping on Canterbury Lane and Devonshire Drive. The project scope includes removal of corrugated metal pipe ranging from 12 inches to 57 inches by 38 inches in diameter, installation of new circular HDPE pipe and elliptical RCP storm sewer, replacement of three precast concrete storm sewer structures, and restoration of concrete curb, sidewalk, driveway apron, and asphalt roadway. Montgomery Township solicited sealed bids electronically through the PennBid Program with a bid opening deadline of 10:00 A.M. on September 1, 2026, at the Township offices located at 1001 Stump Road, Montgomeryville, Pennsylvania 18936. No pre-bid meeting was scheduled for this project.
As a condition of contract award, all contractors and subcontractors must complete this employment verification form, affirming compliance with the Public Works Employment Verification Act through utilization of the federal E-Verify Program operated by the United States Department of Homeland Security. Contractors certify that all employees hired after January 1, 2013, are authorized to work in the United States and agree to verify employment eligibility of all new hires within five business days of the employee start date using the federal E-Verify Program. Documentation of E-Verify usage must be maintained for investigative or audit purposes. The project is subject to Pennsylvania Act 422, the Pennsylvania Prevailing Wage Act as amended, and Act 127, the Pennsylvania Public Works Employment Verification Act as amended. Bid security of not less than ten percent of the bid amount is required, along with an Agreement of Surety certifying that Performance and Payment Bonds will be provided if awarded.
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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: Montgomery Township |
| ContractProject No: 2500999 |
| Project Description: Canterbury Storm Sewer Replacement |
| Project Location: Montgomery Township, Montgomery County, PA |
| Name: |
| Business or Organization Name - Employer: |
| Signature: |
| Check Box1: Off |
| Check Box2: Off |
File details come from the government source that posted it. Updated .