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

This is a Worker Protection and Investment Certification Form from Pennsylvania's Bureau of Workers' Compensation, established pursuant to Executive Order 2021-06 regarding Worker Protection and Investment. The form requires contractors working on Pennsylvania state projects to certify compliance with various labor laws and worker protection statutes, including the Construction Workplace Misclassification Act, Employment of Minors Child Labor Act, Minimum Wage Act, Prevailing Wage Act, Equal Pay Law, and several other employment-related regulations. The certification applies to penalties for providing false certifications, including contract termination and three-year ineligibility for bidding on contracts under 62 Pa. C.S. § 531.

The form establishes that Pennsylvania law requires penalties for contractors who provide false certifications, and contractors must understand that certification subjects them to provisions and penalties under 18 Pa. C.S. § 4904 for unsworn falsification to authorities. The document includes signature fields for the contractor/grantee name, title of certifying official, and date, indicating this is a standard compliance form that must be completed and submitted as part of the contracting process. The form was published on February 4, 2022, and is identified as BOP-2201.