3-Workmens Comp Aff.pdf

This is a Workmen's Compensation Act Affidavit form required by Myerstown Borough, Pennsylvania for contractors bidding on the Walnut Alley Drainage Improvements Project and related roadway projects. The affidavit serves as a sworn attestation that the contractor has accepted the provisions of Pennsylvania's Workmen's Compensation Act of 1915 and maintains required liability insurance coverage in accordance with the Act. The form requires the contractor to identify the surety company providing coverage, obtain notarization, and be executed prior to contract award. Contractors must submit this completed affidavit as part of their bid package for the drainage improvements project, which involves approximately 1,030 linear feet of storm sewer construction with bids due online by 2:00 PM on Wednesday, July 8, 2026.

The affidavit contains no specific pricing information, insurance requirements, or financial terms beyond the requirement that surety companies issuing bonds must be licensed to conduct business in the Commonwealth of Pennsylvania. This document is a mandatory compliance requirement under Pennsylvania law for all public works projects and must be properly executed before a contractor can be awarded a contract. The form requires completion by the contractor's authorized representative and must be notarized, with the notary public's commission expiration date noted on the document.