2-Workmens Comp Aff.pdf

This is a Workmen's Compensation Affidavit form required by Lemoyne Borough in Cumberland County, Pennsylvania for the 10th Street Retaining Wall Rehabilitation Project. The affidavit certifies that contractors have accepted the provisions of the Workmen's Compensation Act of 1915 of the Commonwealth of Pennsylvania and have obtained appropriate insurance liability coverage under the act. Bids for the 10th Street Retaining Wall Rehabilitation Project, which involves 170 linear feet of concrete retaining wall rehabilitation, must be submitted online via PennBID until 2:00 p.m. on Tuesday, June 9, 2026. Questions regarding the project must be submitted online by 4:00 p.m. on Friday, June 5, 2026. All bids must be accompanied by a bid bond equal to 10 percent of the total bid amount, issued by a surety licensed to conduct business in the Commonwealth of Pennsylvania.

The affidavit must be completed, signed by an authorized representative of the contractor, and notarized before submission. The form requires identification of the contracting entity, the surety company providing workers' compensation insurance, and certification by a notary public. This document is a mandatory compliance requirement for participation in the procurement, along with other contractual conditions including compliance with the Pennsylvania Prevailing Wage Act, OSHA requirements, Pennsylvania Act 229 of 2002, the Pennsylvania One Call Act, the Pennsylvania Human Relations Act, non-collusion affidavits, non-discrimination in employment regulations, and the Public Works Employment Verification Act.