2-Public Works Verification Form.pdf
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- Solicitation number
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- Issued by
- Delaware County, Pennsylvania
About this file
Public Works Employment Verification Form Summary
This document is a Public Works Employment Verification Form issued by the Commonwealth of Pennsylvania for use by contractors and subcontractors bidding on public works projects. The form requires bidders to complete and submit documentation prior to contract award, confirming their company's compliance with the Public Works Employment Verification Act through enrollment in the federal E-Verify Program (EVP). The form captures essential company information including legal name, mailing address, contractor or subcontractor status, contracting public body details, contract/project number, project description, and project location. Contractors must provide the date of their E-Verify enrollment and an authorized representative's signature attesting to the accuracy of the information provided.
The form mandates that all contractors and subcontractors utilize the federal E-Verify Program 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 for each new hire must be maintained for potential investigation or audit purposes. The form requires an authorized company representative to sign and date the verification, providing contact information including phone number and email address. This verification form is a mandatory compliance requirement for all public works contracts in Pennsylvania and serves to ensure that contractors meet state employment authorization requirements before project award.
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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
| Company Legal Name: |
| Doing Business As: |
| Street Address 1: |
| Street Address 2: |
| City: |
| State: |
| Zip Code: |
| 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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