4-04 Public Works Employment Verification Form.pdf
PDF 125 KB Posted
- Attached to
- Pavement Marking Improvements Project
- Solicitation number
- Not on record
- Issued by
- Bucks County, Pennsylvania
About this file
The Commonwealth of Pennsylvania Public Works Employment Verification Form is a compliance document required by Northampton Township for contractors and subcontractors bidding on public works projects in Bucks County, Pennsylvania. The form verifies that bidding entities are compliant with the Public Works Employment Verification Act through enrollment and utilization of the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. Contractors and subcontractors must complete and submit the form to the contracting public body prior to contract award, certifying that all employees hired are authorized to work in the United States and that the company will utilize E-Verify to verify employment eligibility of each new hire within five business days of the employee start date throughout the duration of the public works contract. The form requires the authorized company representative to attest that all information provided is true and correct and to maintain documentation confirming E-Verify usage for investigation or audit purposes.
The form applies to Northampton Township's two public works projects: the Pedestrian Crossing Improvement Project with a bid deadline of January 19, 2026, and the 2026 Milling Project with a bid deadline of April 27, 2026. Both projects require bidders to be PennDOT pre-qualified and to comply with the Pennsylvania Prevailing Wage Act. All subcontractors must similarly maintain PennDOT pre-qualification status. Bids must be submitted electronically via PennBid and include a 10 percent bid guarantee. No bids may be withdrawn within 60 days following the opening, and the successful bidders must maintain workers' compensation and public liability insurance. The completion period for the Pedestrian Crossing Improvement Project is 240 calendar days from the Notice to Proceed, with liquidated damages of $975.00 per calendar day assessed for project delays, and all work carries a 24-month guarantee from the date of final acceptance.
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Text version
Street Address 2
City State Zip Code
Doing Business As:
(if different from Legal Name)
Commonwealth of Pennsylvania Public Works Employment Verification Form
Complete and return the form to the contracting Public Body prior to the award of the contract.
Company Legal Name: ___________________________________________________________
Mailing Address: ______________________________________________________
Check one: Contractor Subcontractor
Contracting Public Body: _________________________________________________________
Contract/Project Number: ________________________________________________________
Project Description: _____________________________________________________________
Project Location: _______________________________________________________________
Date Enrolled in E-Verify (MM/DD/YYYY): ___________________________________________ As a contractor/subcontractor for the above referenced public works contract, I hereby affirm that as of today’s 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 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 of Signature
Printed Name: _________________________________________________________________
Phone Number: ______________________ Email: ____________________________________
Street Address 1
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| Contractor: Off |
| Subcontractor: Off |
| Contracting Public Body: |
| ContractProject Number: |
| Project Description: |
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| Printed Name: |
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| Today's Date: |
| Name of Authorized Representative: |
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