8-Exhibit I - Public Works Verification Form.pdf
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- Solicitation number
- Not on record
- Issued by
- Montgomery County, Pennsylvania
About this file
This is a Public Works Employment Verification Form issued by the Commonwealth of Pennsylvania for use by contractors and subcontractors on public works projects. The form serves as a compliance document through which contractors must certify their enrollment and participation in the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security prior to contract award. The form requires contractors to complete company information including legal name, mailing address, contracting public body, contract/project number, and project description. Contractors must affirm their compliance with Pennsylvania's Public Works Employment Verification Act and confirm that all current employees are authorized to work in the United States. Additionally, contractors agree to utilize E-Verify to verify employment eligibility for all new hires within five business days of the employee start date throughout the duration of the public works contract, with documentation maintained for potential investigations or audits. The authorized representative must sign and date the form, providing printed name, phone number, and email address.
The form contains no specific pricing terms, set-asides, or funding information, as it functions as a compliance certification document rather than a procurement specification. The form applies to all contractors and subcontractors on public works projects governed by Pennsylvania law and does not include renewal options or contract term specifications, as these details would be contained in the underlying contract documents. Completion and return of this verification form is a prerequisite to contract award and represents a mandatory compliance requirement under Pennsylvania's Public Works Employment Verification Act.
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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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