6-Workmens Comp Aff.pdf

This is a Workmen's Compensation Affidavit required by Wormleysburg Borough, Pennsylvania for the 2026 Street Rehab Project and related infrastructure initiatives. The affidavit serves as a sworn statement in which contractors affirm their acceptance of the provisions of the Pennsylvania Workmen's Compensation Act of 1915, including all supplements and amendments. Contractors must certify that they have obtained liability insurance coverage under the Act with an approved surety company and must provide the affidavit notarized by a public notary before submitting their bid proposal online through PennBID by the established deadlines (September 30, 2025 for the South Front Street Sewer Lining Project and July 8, 2026 for the 2026 Street Rehab Project).

This mandatory compliance document requires the contractor to identify the surety company providing workmen's compensation insurance, include the contractor's signature, and obtain notarization with an expiration date clearly stated. The affidavit is a standard attachment in Wormleysburg Borough's bid packages and represents a prerequisite requirement for bid eligibility, ensuring that all prospective contractors maintain proper workers' compensation coverage as mandated by Pennsylvania law before engaging in municipal public works projects.