3-PW Employment Verification Form.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 Public Works Employment Verification Form issued by the Commonwealth of Pennsylvania for use by contractors and subcontractors working on public works projects. The form applies to the Upper Leacock Township 2026 Roadway Project - Contract No. 1 - Paving, a roadway infrastructure improvement project located in Lancaster County, Pennsylvania. The project 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 on three primary roads: Ridgeview Drive, Fiddler Green Road, and Hickory Lane, with two alternate bids available for Snakehill Road and Logging Road. Electronic bids must be submitted through PennBID no later than 2:00 PM on Tuesday, April 7, 2026, with questions due by 4:00 PM on Friday, April 3, 2026. All work must be completed by September 8, 2026. Successful contractors must provide performance and payment bonds equal to 100 percent of the contract price within 10 days of notice of award, along with required insurance coverage including general liability, automobile liability, and contractual liability.
The verification form requires contractors and subcontractors to affirm compliance with the Public Works Employment Verification Act through utilization of the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. Contractors must confirm that all employees hired after January 1, 2013 are authorized to work in the United States and agree to utilize the federal EVP to verify employment eligibility of each new hire within five business days of the employee start date throughout the contract duration. Documentation confirming use of the federal EVP must be maintained in the event of investigation or audit. The authorized representative executing the form attests that the information is true and correct, with understanding that submission of false or misleading information is subject to sanctions provided by law.
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Text version
COMMONWEALTH OF PENNSYLVANIA
PUBLIC WORKS EMPLOYMENT VERIFICATION FORM
Date _______________________
Business or Organization Name (Employer)_________________________________________________
Address _____________________________________________________________________________
City _____________________________________ State_____________ Zip Code ________________
Contractor {dzōŎƻƴǘNJŀŎǘƻNJ όŎƘŜŎƪ ƻƴŜύ
Contracting Public Body _______________________________________________________________
Contract/Project No ___________________________________________________________________
Project Description ____________________________________________________________________
Project Location ______________________________________________________________________
As a contractor/subcontractor for the above referenced public works contract, I hereby affirm that as of the above 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 post
January 1, 2013 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: |
| Address: |
| City: |
| State: |
| Zip Code: |
| Contracting Public Body: |
| ContractProject No: |
| Project Description: |
| Project Location: |
| Name: |
| Business or Organization Name - Employer: |
| Signature: |
| Check Box1: Off |
| Check Box2: Off |
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