8-05 Public Works Employment Verification Form.pdf
PDF 125 KB Posted
- Attached to
- Intersection Improvement Project - Layfield Road (S. R. 0663) and Schoolhouse Road (T-239)/Montgomery Avenue
- Solicitation number
- Not on record
- Issued by
- Montgomery 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 must be completed and submitted to the contracting public body prior to contract award. It applies to the Intersection Improvement Project at Layfield Road (S.R. 0663) and Schoolhouse Road (T-239)/Montgomery Avenue in Upper Hanover Township, Montgomery County, Pennsylvania. Bids for this project are due by 1:00 PM on October 30, 2026, via PennBID. All bidders and subcontractors must be PennDOT pre-qualified and comply with 67 PA Code Chapter 457 and PennDOT Form 408/2026 requirements. A bid bond or certified check equal to 10 percent of the total bid must accompany all proposals. The successful bidder must comply with the Pennsylvania Prevailing Wage Act, with prevailing wage rates determined on September 2, 2026, under Serial Number 26-08009. No bid may be withdrawn within sixty days after opening.
The form requires that contractors and subcontractors affirm compliance with the Public Works Employment Verification Act through enrollment in the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. All employees must be verified as authorized to work in the United States, with new hires verified within five business days of their start date. Documentation confirming E-Verify usage must be maintained for investigation or audit purposes. The authorized company representative must attest that all information provided is true and correct, with submission of false or misleading information subject to legal sanctions. The Township reserves the right to waive minor informalities or reject any or all bids.
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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
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| Contractor: Off |
| Subcontractor: Off |
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