30-Doc 00 73 00.21 Attach B-Public Works Employment Verification Form.pdf
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- Bucks 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 on public works projects. The form is specifically associated with Contract 2400754 for the Fanny Chapman Memorial Pool Main Pool Repairs project in the Borough of Doylestown, Pennsylvania. The form requires contractors to verify compliance with the Public Works Employment Verification Act (Act 127) through participation in the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. All employees hired on or after January 1, 2013, must be verified as authorized to work in the United States within five business days of the employee start date. Documentation confirming E-Verify usage for each new hire must be maintained throughout the duration of the public works contract and retained for potential investigations or audits. The form requires an authorized company representative to attest under penalty of law that the information provided is true and correct.
The completion and submission of this employment verification form is a mandatory compliance requirement for all contractors and subcontractors bidding on or performing work under the Fanny Chapman Memorial Pool project. Sealed bids for the main pool repairs are due September 22, 2025, at 2:00 PM via the PennBid Program, with a non-mandatory pre-bid meeting scheduled for September 4, 2025, at 10:00 AM. The project is subject to Pennsylvania Prevailing Wage Act (Act 422) requirements and all applicable provisions of Act 127. Contractors must submit this verification form as part of their bid documentation to demonstrate their commitment to employing only legally authorized workers and compliance with state workforce verification mandates.
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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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