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

This document is a Worker Protection and Investment Certification Form issued by the Commonwealth of Pennsylvania pursuant to Executive Order 2021-06. The form requires contractors and grantees to certify compliance with Pennsylvania's labor and workforce safety laws, including 13 specific statutes ranging from the Construction Workplace Misclassification Act to the Apprenticeship and Training Act.

The certification explicitly states that Pennsylvania law establishes penalties for providing false certifications, including potential contract termination and a three-year ineligibility to bid on contracts under 62 Pa. C.S. § 531. Contractors/grantees must confirm they are compliant with all listed labor and workplace safety laws, understand the requirement to report any changes in compliance status immediately, and acknowledge that this certification is subject to the provisions and penalties of 18 Pa. C.S. § 4904 (Unsworn falsification to authorities). The form is to be signed by an authorized official, with spaces provided for signature, name, title, and contractor/grantee name.