5-004526 - Wrkmns Comp. Affidavit.pdf

This is a Worker's Compensation Affidavit form required for the New Holland Pike Low-Pressure Force Main Replacement Project being procured by the Upper Leacock Township Municipal Authority in Pennsylvania. The affidavit serves as a certification document in which contractors affirm that they have accepted the provisions of Pennsylvania's Worker's Compensation Act of 1915 and have obtained appropriate insurance coverage for their liability under the Act. The form requires the contractor to identify themselves, designate their surety company, provide signatures, and have the document notarized. This affidavit is a standard compliance requirement for bidders on the project, with sealed bids due online by 10:00 AM on November 5, 2026, and a voluntary pre-bid meeting scheduled for October 29, 2026, at 1:00 PM at 161 Newport Road, Leola, PA 17540.

Bidders are required to submit a certified check or bid bond equal to 10% of their total bid, with bonds issued by a surety licensed in Pennsylvania. The successful bidder must furnish performance and payment bonds totaling 100% of the contract price and must substantially complete the project within 315 calendar days of receiving the Notice to Proceed. Bids remain open for 60 days from the opening date, or 120 days if delayed by governmental approval, bond sales, or grant awards. The project is subject to compliance with the Pennsylvania Prevailing Wage Act, OSHA requirements, Pennsylvania Act 229 of 2002, the Pennsylvania One Call Act, and the Pennsylvania Human Relations Act 222.