2-e-Verify Compliance Form PDF Fill-In.pdf
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- Solicitation number
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- Issued by
- York County, Refton CDP, Pennsylvania
About this file
This is a Public Works Employment Verification Form required by the Commonwealth of Pennsylvania for contractors and subcontractors on public works projects, specifically applicable to the Franklin & Country Club Road Storm Sewer Replacement and 2026 Road Maintenance project in Red Lion Borough, York County, Pennsylvania. Contractors and subcontractors must complete and submit this form to the contracting public body prior to contract award. The form documents the company's compliance with the Public Works Employment Verification Act through enrollment in the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. All contractors and subcontractors are required to utilize E-Verify to verify employment eligibility of each new hire within five business days of the employee start date throughout the duration of the public works contract. Documentation confirming E-Verify usage must be maintained for investigation or audit purposes.
The form requires submission of company legal name, mailing address, contracting public body information, contract or project number, project description and location, E-Verify enrollment date, and contact information for an authorized representative. The authorized representative must attest under penalty of law that all information provided is true and correct and that all employees hired are authorized to work in the United States. Submission of false or misleading information subjects the contractor to sanctions provided by law. Sealed bids for this project are due by 10:00 AM on Thursday, January 29, 2026, via the PennBid Program, with bid results available the same day. A bid bond or certified check in the amount of 10% of the maximum bid must accompany each bid submission. The project is subject to Pennsylvania Prevailing Wage Act provisions.
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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
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| Street Address 1: |
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| City: |
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| 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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