5-004526 - Wrkmns Comp. Affidavit.pdf

This is a Worker's Compensation Affidavit form required by the Hermitage Municipal Authority for the Gabion Wall Repair project in Pennsylvania. The affidavit certifies that the contractor has accepted the provisions of the Worker's Compensation Act of 1915 of the Commonwealth of Pennsylvania and has obtained appropriate insurance coverage for worker's compensation liability in accordance with state law. The form requires the contractor to identify the surety company providing the worker's compensation coverage and must be notarized with the notary public's commission expiration date documented. Sealed bids for the Gabion Wall Repair project are due by 10:00 AM on January 27, 2026, submitted online through the PennBID website, with successful completion required within 180 calendar days of receiving the Notice to Proceed.

Bidders must submit a certified check or bid bond equal to 10% of the total bid amount, issued by a surety licensed in Pennsylvania. The successful contractor will be required to furnish performance and payment bonds in the amount of 100% of the contract price. Bids will remain open for 60 days from the bid opening date, or 120 days if award is delayed by governmental approval, bond sales, or grant awards. The project is subject to compliance with the Pennsylvania Prevailing Wage Act, OSHA regulations, Pennsylvania Act 229 of 2002, the One Call Act, the Human Relations Act, non-discrimination employment requirements, the Public Works Employment Verification Act, and execution of a Non-Collusion/Sexual Harassment Affidavit.