2-004546 - Public Works Employment Verification Form.pdf
PDF 83 KB Posted
- Attached to
- Grit System Replacement
- Solicitation number
- Not on record
- Issued by
- Cumberland County, Pennsylvania
About this file
This is a Public Works Employment Verification Form submitted by a contractor or subcontractor to the Lemoyne Municipal Authority for the Grit System Replacement Project located in Lemoyne Borough, Cumberland County, Pennsylvania (Contract/Project No. 112692012). The project involves the replacement of a grit system, with bids accepted online through PennBID until 2:00 PM on October 6, 2026. The successful bidder must substantially complete the project within 180 calendar days of receiving the Notice to Proceed. A certified check or bid bond equal to 10% of the total bid is required at submission, with performance and payment bonds in the amount of 100% of the Contract Price required from the selected contractor. Bids remain open for 60 days from the date of bid opening, or 120 days if award is delayed by governmental approval, bond sales, or grant awards.
The contract is subject to the Pennsylvania Prevailing Wage Act, the Federal Occupational Safety and Health Act of 1970 (OSHA), Pennsylvania Act 229 of 2002, the Pennsylvania One Call Act (Act 287 of 1974), the Pennsylvania Human Relations Act, and the Pennsylvania Public Works Employment Verification Act. All contractors and subcontractors must verify employment eligibility through the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security for all employees hired after January 1, 2013, and must complete verification within five business days of each new hire's start date. Documentation of E-Verify usage must be maintained for investigation or audit purposes. All bidders must submit a Non-Collusion Affidavit and comply with non-discrimination in employment and contract compliance regulations.
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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 Subcontractor (check one)
Contracting Public Body Lemoyne Municipal Authority
Contract/Project No 112692012
Project Description Grit System Replacement
Project Location Lemoyne Borough, Cumberland County, Lemoyne, Pennsylvania
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 employees 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
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