9-Public Works Employment Verification Form.pdf
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- 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 within the state. The form is required to be completed and submitted to the contracting public body prior to contract award for the Sumneytown Pike (SR 0063) Signal System Upgrade project in Towamencin Township, Montgomery County, Pennsylvania. Contractors and subcontractors must verify 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. The form requires documentation of the company's legal name, mailing address, project details, and the date of E-Verify enrollment. All contractors and subcontractors must utilize E-Verify to verify employment eligibility of each new hire within five business days of the employee start date throughout the duration of the public works contract, with documentation maintained for potential investigation or audit.
The authorized representative must attest under penalty of law that all information provided on the form is true and correct, and affirm that to the best of their knowledge, all employees hired are authorized to work in the United States. Submission of false or misleading information is subject to sanctions provided by law. The form requires the signature and date of the authorized representative, along with printed name, phone number, and email address. This verification requirement applies to all bidders and subcontractors on the project, consistent with Pennsylvania's prequalification regulations under 67 PA Code Chapter 457 and PennDOT Form 408/2020. Bidders must submit sealed proposals by 10:00 a.m. on December 18, 2025, via PennBid, and all bids must include a bid bond or certified check equal to 10 percent of the total bid amount.
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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 |
| Contracting Public Body: |
| ContractProject Number: |
| Project Description: |
| Project Location: |
| Printed Name: |
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| Today's Date: |
| Name of Authorized Representative: |
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