2-17b. Public Works Employment Verification Form.pdf

PUBLIC WORK EMPLOYMENT VERIFICATION ACT

General. In accordance with Act 127 of 2012, known as the Public Works Employment Verification Act (“the Act”), effective January 1, 2013, 43 P.S.

§§167.1-167.11, use the Federal Government’s E-Verify system to ensure that all employees performing work on the project, including subcontractor’s employees, are authorized to work in the United States.

Verification Form. Verify the employment eligibility of each new employee hired after January 1, 2013 and submit the Commonwealth Public Works Employment Verification Form (“Form”) included in the bid package attachments to the Department.

Contractor. Fax the Form, signed by authorized representative of the Contractor, possessing sufficient knowledge to make the representations and certifications in the Form to Contract Awards at 717-705-1504 within 7 days of the bid opening. Failure or refusal to provide the Form will be considered a refusal to comply with bidding requirements, will result in rejection of the bid, and will be subject to the enforcement activities, sanctions and civil penalties specified in the Act.

Subcontractor. Obtain a signed Form from every subcontractor performing work on the project, signed by authorized representative of the subcontractor, possessing sufficient knowledge to make the representations and certifications in the Form and submit it to the Representative when requesting subcontractor approval. Failure or refusal to provide the Form will be considered a refusal to comply with subcontractor approval requirements, will result in rejection of the subcontractor request, and will subject the subcontractor to the enforcement activities, sanctions and civil penalties specified in the Act.

Include information about the requirements of the Act in all the subcontracts.

The Department of General Services is the Commonwealth agency responsible for enforcement and administration of the Act. Please direct questions about the Act to:

Department of General Services Public Works Employment Verification Compliance Office Room 105 Tent Building 18th and Herr Streets Harrisburg, PA 17125 Fax: 717-214-3669

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