6-004546 - Public Works Employment Verification Form.pdf
PDF 124 KB Posted
- Attached to
- Leola Community Park
- Solicitation number
- Not on record
- Issued by
- Lancaster County, Pennsylvania
About this file
This is a Public Works Employment Verification Form required by the Commonwealth of Pennsylvania for contractors and subcontractors on public works projects. The form applies to multiple procurement opportunities issued by Upper Leacock Township in Lancaster County, Pennsylvania, including the 2026 Roadway Projects (Contract No. 1 - Paving and Contract No. 2 - Bituminous Seal Coat) and the Leola Community Park Project. Contractors must complete and submit the form to the contracting public body prior to contract award, certifying compliance with the Public Works Employment Verification Act through enrollment in the federal E-Verify Program operated by the United States Department of Homeland Security. All contractors and subcontractors are required to verify the employment eligibility of each new hire within five business days of the employee start date and maintain documentation of E-Verify usage throughout the duration of the contract. The form requires the authorized representative to attest under penalty of law that all information provided is true and correct, with submission of false or misleading information subject to legal sanctions.
The form serves as a mandatory compliance document with no pricing terms, set-asides, or funding information contained within it. Rather, it functions as a prerequisite verification tool ensuring that all personnel working on public works projects are authorized to work in the United States. Contractors must provide their company legal name, mailing address, contract/project number, project description, project location, date of E-Verify enrollment, and contact information for the authorized representative signing the form. Failure to submit this verification form prior to contract award will prevent the contractor from proceeding with the awarded contract, making it a critical administrative requirement for all bidders seeking to work on Pennsylvania public works projects.
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Text version
Street Address 2
City State Zip Code
Doing Business As:
(if different from Legal Name)
Commonwealth of Pennsylvania Public Works Employment Verification Form
Complete and return the form to the contracting Public Body prior to the award of the contract.
Company Legal Name: ___________________________________________________________
Mailing Address: ______________________________________________________
Check one: Contractor Subcontractor
Contracting Public Body: _________________________________________________________
Contract/Project Number: ________________________________________________________
Project Description: _____________________________________________________________
Project Location: _______________________________________________________________
Date Enrolled in E-Verify (MM/DD/YYYY): ___________________________________________ As a contractor/subcontractor for the above referenced public works contract, I hereby affirm that as of today’s 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 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 of Signature
Printed Name: _________________________________________________________________
Phone Number: ______________________ Email: ____________________________________
Street Address 1
| Company Legal Name: |
| Doing Business As: |
| Street Address 1: |
| Street Address 2: |
| City: |
| State: |
| Zip Code: |
| Contractor: Off |
| Subcontractor: Off |
| Contracting Public Body: |
| ContractProject Number: |
| Project Description: |
| Project Location: |
| Printed Name: |
| Phone Number: |
| Email: |
| Today's Date: |
| Name of Authorized Representative: |
| MM/DD/YYYY: |
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