04. BOP-2201 WORKER PROTECTION AND INVESTMENT CERTIFICATION FORM.pdf

This is a Worker Protection and Investment Certification Form from the Commonwealth of Pennsylvania, issued pursuant to Executive Order 2021-06 (dated October 21, 2021). The form requires contractors and grantees to certify compliance with Pennsylvania's labor and workforce safety laws, including 13 specific acts covering areas such as workplace classification, minimum wage, equal pay, employment medical examinations, seasonal farm labor, wage payment, industrial homework, employee verification, overtime in healthcare, apprenticeship, and employment records.

The form establishes penalties for false certifications, including contract termination and three-year debarment from bidding on contracts under 62 Pa. C.S. § 531. Contractors must report any compliance status changes immediately to the Purchasing Agency, and false statements are subject to penalties under 18 Pa. C.S. § 4904. The form requires signature, date, printed name, title of certifying official, and contractor/grantee name. The document was published on February 4, 2022 with form number BOP-2201.