5-Public Works Employment Verification Form.pdf

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Attached to
State Theatre External Rehabilitation
Solicitation number
Not on record
Issued by
Fulton County, Pennsylvania

About this file

This is a Public Works Employment Verification Form from the Commonwealth of Pennsylvania required for contractors and subcontractors on the State Theatre External Rehabilitation project administered by the Redevelopment Authority of the City of Uniontown. The form certifies compliance with the Public Works Employment Verification Act through participation in the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. All contractors and subcontractors must verify that employees hired after January 1, 2013 are authorized to work in the United States and agree to utilize E-Verify for all new hires within five business days of the employee start date throughout the duration of the public works contract. Documentation confirming E-Verify usage must be maintained for potential investigations or audits. The form requires the authorized representative of the company to attest under penalty of law that the information provided is true and correct.

This verification form is a mandatory compliance document that applies to all bidders and awarded contractors on the State Theatre External Rehabilitation project in Uniontown, Pennsylvania, which is funded through the Community Development Block Grant Program. Submission of false or misleading information on the verification form subjects violators to sanctions provided by law. The form must be submitted as part of the bid package for the sealed bid invitation with a submission deadline of Wednesday, January 7th, 2026, via PennBid at https://pennbid.bonfirehub.com/.

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COMMONWEALTH OF PENNSYLVANIA

PUBLIC WORKS EMPLOYMENT VERIFICATION FORM

Date

Business or Organization Name (Employer)

Address

City State Zip Code

Contractor Subcontractor (check one)

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

File details come from the government source that posted it. Updated .