3-004526 - Workers Comp. Affidavit.pdf

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Attached to
Northwood Water Main Replacement
Solicitation number
Not on record
Issued by
Blair County, Pennsylvania

About this file

This is a Worker's Compensation Affidavit required by the Borough of Tyrone, Pennsylvania for the Northwood Water Main Replacement project. The affidavit documents a contractor's acceptance of the provisions of the Worker's Compensation Act of 1915 of the Commonwealth of Pennsylvania and confirms that the contractor has insured their liability under the Act with an approved surety company. The form is a notarized declaration to be completed and signed by the contractor, with attestation by a Notary Public. Sealed bids for the project are due online by 10:00 AM on Wednesday, April 8th, with a voluntary pre-bid meeting scheduled for Thursday, March 18 at 10:00 AM at the Tyrone Borough Building located at 1100 Logan Avenue, Tyrone, PA 16686. The successful bidder must substantially complete the project within 120 calendar days of receipt of the Notice to Proceed.

A certified check or bid bond equal to 10% of the total bid is required at submission, with bonds to be issued by a surety licensed in Pennsylvania. The successful bidder must furnish performance and payment bonds in the amount of 100% of the Contract Price. Bids shall remain open for 60 days from the date of bid opening, or 120 days if award is delayed by governmental agency approval, bond sale, or grant award. All bidders must bid on all items listed on the Bid Form. The contract is subject to Pennsylvania Prevailing Wage Act conditions, Federal OSHA requirements, Pennsylvania Act 229 of 2002, the Underground Utility Line Protection Law, the Pennsylvania Human Relations Act, and non-discrimination in employment and contract compliance regulations.

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Text version

WORKER’S COMPENSATION AFFIDAVIT

STATE OF )

( ss

COUNTY OF )

being duly sworn according to law deposes and says that they have accepted the provisions of the Worker's Compensation Act of 1915 of the Commonwealth of Pennsylvania, with its supplements and amendments, and have insured their liability thereunder in accordance with the terms of said Act with .

(SURETY COMPANY)

Contractor (type or print name)

By:

Signature

Sworn to and subscribed before me this day of .

Notary Public My Commission Expires:

WORKER’S COMPENSATION AFFIDAVIT

File details come from the government source that posted it. Updated .