2-MS944 Workers Comp Aff.pdf
PDF 31 KB Posted
- Attached to
- Commerce Street Improvement Project
- Solicitation number
- Not on record
- Issued by
- Adams County, Pennsylvania
About this file
This file is a Workers' Compensation Affidavit form required by New Oxford Borough for the Commerce Street Improvement Project in Pennsylvania. The affidavit certifies that a contractor has accepted the provisions of the Workmen's Compensation Act of 1915 of the Commonwealth of Pennsylvania and maintains insured liability in accordance with the Act's terms. The document requires the contractor to identify the applicable surety company and be executed before a notary public. This affidavit serves as a mandatory compliance document for the Commerce Street Improvement Project, which includes 2,750 square yards of milling, 700 tons of binder/leveling course, 260 tons of wearing course, and other specified work. Bids for this project were due by Thursday, April 23, 2026, at 2:00 PM, with all solicitation details available through PennBID at https://pennbid.bonfirehub.com.
A certified check or bid bond equal to 10 percent of the total bid amount is required, with bonds issued only by sureties licensed to conduct business in Pennsylvania. The contract is subject to multiple regulatory requirements including the Pennsylvania Prevailing Wage Act, OSHA regulations, Act 229 of 2002, the One Call Act (Act 287 of 1974), the Human Relations Act, noncollusion affidavit requirements, non-discrimination employment compliance regulations, and the Public Works Employment Verification Act. New Oxford Borough Council reserves the right to accept or reject any or all bids submitted for the project.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Attachment 4
AFFIDAVIT RE:
ACCEPTING PROVISIONS OF THE WORKMEN’S COMPENSATION ACT
STATE OF PENNSYLVANIA )
( ss:
COUNTY OF ADAMS)
being duly sworn according to law deposes and says that accepted the provisions of the Workmen’s Compensation Act of 1915 of the Commonwealth of Pennsylvania, with its supplements and amendments, and insured liability thereunder in accordance with the terms of said Act with .
(SURETY COMPANY)
(TYPE OR PRINT) CONTRACTOR
By:
SIGNATURE
Sworn to and subscribed before me this day of A.D. 20 .
SIGNATURE: NOTARY PUBLIC
MY COMMISSION EXPIRES: (DATE)
File details come from the government source that posted it. Updated .