41-Doc 00 73 00 5 - Appendix B - Public Works Employment Verification Form.pdf
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- Attached to
- 234 McKean Road Demolition (26-00182)
- Solicitation number
- Not on record
- Issued by
- Montgomery County, Pennsylvania
About this file
This is a Public Works Employment Verification Form issued by the Commonwealth of Pennsylvania for use in public works contracting. The form is required for contractors and subcontractors working on the 234 McKean Road Demolition project (Contract No. 26-00182) in Horsham Township, Pennsylvania. The project scope includes demolition of a residential home, detached garage, two sheds, and asphalt driveway removal, along with domestic water well capping, sanitary service line abandonment, temporary restoration of a stream crossing damaged by previous flooding, and site grading and stabilization of all disturbed areas. A mandatory pre-bid meeting is scheduled for Thursday, April 2, 2026, at 1100 Limekiln Pike, Ambler, Pennsylvania 19002, beginning at 11:00 a.m. Contractors and subcontractors must complete and submit this verification form to demonstrate compliance with the Public Works Employment Verification Act prior to contract award.
The form requires the contractor or authorized subcontractor representative to affirm, under penalty of law, that the company is in compliance with Pennsylvania's 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. All employees hired on or after January 1, 2013, must be verified as authorized to work in the United States. Contractors and subcontractors are obligated to use the federal EVP to verify employment eligibility of each new hire within five business days of the employee's start date throughout the duration of the public works contract. Documentation confirming E-Verify usage for each new hire must be maintained for investigation or audit purposes. Submission of false or misleading information on the verification form subjects the contractor to sanctions under applicable 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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