3-MS944 Workers Comp Aff.pdf

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Attached to
Leola Community Park
Solicitation number
Not on record
Issued by
Lancaster County, Pennsylvania

About this file

This is a Workers' Compensation Affidavit attachment related to a 2026 Roadway Projects bid solicitation issued by Upper Leacock Township in Pennsylvania. The affidavit serves as a required compliance document for contractors bidding on Contract No. 1 - Paving and Contract No. 2 - Bituminous Seal Coat. Contract No. 1 encompasses approximately 34,780 square yards of milling, 34,780 square yards of paving fabric, 1,655 tons of bituminous leveling course, and 3,310 tons of bituminous wearing course. Contract No. 2 includes approximately 47,650 square yards of bituminous seal coat with double application. Online bids must be submitted through PennBID by Tuesday, April 7, 2026, at 2:00 PM, with bid updates permitted until that deadline. Questions must be submitted online through PennBID no later than 4:00 PM on Friday, April 3, 2026. No pre-bid meeting will be held for this project.

Bidders are required to submit a certified check or bid bond equal to ten percent of the total bid amount, with bonds to be issued by a surety licensed to operate in Pennsylvania. The project is subject to multiple regulatory requirements, including the Pennsylvania Prevailing Wage Act for Contract No. 1, Federal OSHA conditions, Pennsylvania Act 229 of 2002, the Pennsylvania One Call Act, the Pennsylvania Human Relations Act, non-collusion affidavit requirements, and non-discrimination in employment and contract compliance regulations. This affidavit specifically requires contractors to affirm acceptance of the provisions of the Workmen's Compensation Act of 1915 and confirmation that liability insurance is maintained in accordance with the Act. Upper Leacock Township reserves the right to accept or reject any or all bids submitted.

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Text version

Attachment 4

AFFIDAVIT RE:

ACCEPTING PROVISIONS OF THE WORKMEN’S COMPENSATION ACT

STATE OF PENNSYLVANIA )

( ss:

COUNTY OF LANCASTER )

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 .