5-Workmen comp addifavit.pdf

This is a Worker's Compensation Affidavit form required by Upper Leacock Township in Lancaster County, Pennsylvania for contractors bidding on state and local projects. The affidavit serves as a sworn declaration that the contractor has accepted the provisions of Pennsylvania's Worker's Compensation Act of 1915 and has obtained appropriate insurance coverage through a surety company authorized to operate in Pennsylvania. The form requires the contractor to provide their legal name, signature, and the name of the surety company providing coverage, with the affidavit to be notarized by a public notary. This documentation is a standard compliance requirement for public works projects in Pennsylvania, including the Leola Community Park construction project and the 2026 Roadway Projects that Upper Leacock Township is soliciting bids for, with bid submission deadlines of April 7, 2026, and August 13, 2026, respectively.

The Worker's Compensation Affidavit is mandatory for all contractors seeking to be awarded contracts on Pennsylvania public works projects as part of the state's regulatory framework governing construction and infrastructure improvement work. Contractors must submit the completed, notarized affidavit as evidence of compliance with worker's compensation insurance requirements before contract execution. This requirement ensures that all workers employed on the project are covered under Pennsylvania's worker's compensation system and protects both the public entity and workers from liability exposure.