04. Appendix C - Worker Protection Form (1).pdf
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- Solicitation number
- 6100066636
- Issued by
- Pennsylvania
About this file
This is a Worker Protection and Investment Certification Form required by the Commonwealth of Pennsylvania's Department of General Services for the statewide Invitation for Bid 6100066636 covering Medical Supplies, Equipment, Nutritional Supplements, and Incontinent Supplies. The solicitation seeks suppliers to provide medical supplies, rapid testing kits and accompanying services, medical equipment, nutritional supplements, and incontinent supplies for use across hospitals, short and long-term living facilities, rehabilitation facilities, and other healthcare settings throughout the Commonwealth. The bid is divided into four categories to allow for comprehensive coverage of the Commonwealth's statewide healthcare supply requirements. Questions regarding the solicitation must be submitted by October 9, 2026, by end of day via email to jahildebra@pa.gov, with bids submitted exclusively through the PA Supplier Portal at www.pasupplierportal.state.pa.us. Bidders must be responsible and responsive and submit all required documentation by the bid due date to be considered for award.
All contractors and grantees responding to this solicitation must complete and submit the Worker Protection and Investment Certification Form, certifying compliance with Pennsylvania's Unemployment Compensation Law, Workers' Compensation Law, and applicable state labor and workforce safety laws including the Construction Workplace Misclassification Act, Employment of Minors Child Labor Act, Minimum Wage Act, Prevailing Wage Act, Equal Pay Law, and other specified statutes. The certification must be executed by an official duly authorized to bind the contractor or grantee and is subject to penalties for false certification, including contract termination and three-year ineligibility to bid on Commonwealth contracts under 62 Pa. C.S. 531. Contractors must immediately report any changes in their compliance status to the purchasing agency.
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Text version
WORKER PROTECTION AND INVESTMENT CERTIFICATION FORM
A. Pursuant to Executive Order 2021-06, Worker Protection and Investment (October 21, 2021), the Commonwealth is responsible for ensuring that every worker in Pennsylvania has a safe and healthy work environment and the protections afforded them through labor laws. To that end, contractors and grantees of the Commonwealth must certify that they are in compliance with Pennsylvania’s Unemployment Compensation Law, Workers’ Compensation Law, and all applicable Pennsylvania state labor and workforce safety laws including, but not limited to:
1. Construction Workplace Misclassification Act
2. Employment of Minors Child Labor Act
3. Minimum Wage Act
4. Prevailing Wage Act
5. Equal Pay Law
6. Employer to Pay Employment Medical Examination Fee Act
7. Seasonal Farm Labor Act
8. Wage Payment and Collection Law
9. Industrial Homework Law
10. Construction Industry Employee Verification Act
11. Act 102: Prohibition on Excessive Overtime in Healthcare
12. Apprenticeship and Training Act
13. Inspection of Employment Records Law
B. Pennsylvania law establishes penalties for providing false certifications, including contract termination; and three-year ineligibility to bid on contracts under 62 Pa. C.S. § 531 (Debarment or suspension).
CERTIFICATION
I, the official named below, certify I am duly authorized to execute this certification on behalf of the contractor/grantee identified below, and certify that the contractor/grantee identified below is compliant with applicable Pennsylvania state labor and workplace safety laws, including, but not limited to, those listed in Paragraph A, above. I understand that I must report any change in the contractor/grantee’s compliance status to the Purchasing Agency immediately. I further confirm and understand that this Certification is subject to the provisions and penalties of 18 Pa. C.S. § 4904 (Unsworn falsification to authorities).
Signature Date
Name (Printed)
Title of Certifying Official (Printed)
Contractor/Grantee Name (Printed)
BOP-2201
Published: 02/04/2022
| WORKER PROTECTION AND INVESTMENT CERTIFICATION FORM |
| CERTIFICATION |
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