42-Doc 00 73 00 5 - Appendix B - Public Works Employment Verification Form.pdf
PDF 63 KB Posted
- Attached to
- 124 Easton Road Demolition 25-01189. 01
- Solicitation number
- Not on record
- Issued by
- Pennsylvania
About this file
This is a Public Works Employment Verification Form issued by the Commonwealth of Pennsylvania for use by contractors and subcontractors engaged in public works projects. The form is required for the 124 Easton Road Demolition project (Contract No. 25-01189.01) in Pennsylvania, which involves the demolition of the Shelby Apartments building located at 111-124 Easton Road, including associated concrete patios and asphalt parking lot, along with environmental remediation within the building and site restoration to match existing grading and stabilization.
The form requires contractors and subcontractors to affirm compliance with Pennsylvania's Public Works Employment Verification Act by verifying all employee work authorization through the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. All employees hired after January 1, 2013, must be verified as authorized to work in the United States, with new hires verified within five business days of their start date throughout the contract duration. Contractors must maintain documentation of E-Verify usage and submit a signed verification form attesting under penalty of law that all information is true and correct. An authorized representative must sign and date the form, providing company name, address, and project details.
View the file
Other files
Show 40 more
Latest 50 of 55 listed here. See the rest on GovTribe.
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 |
File details come from the government source that posted it. Updated .