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, related 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 such as the Construction Workplace Misclassification Act, Employment of Minors Child Labor Act, Minimum Wage Act, and Prevailing Wage Act.

The document outlines 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. The certification requires an authorized official to verify that the contractor/grantee is compliant with all applicable Pennsylvania state labor and workplace safety laws, with an understanding that any changes in compliance status must be reported immediately. The form must be signed and includes fields for the official's signature, printed name, title, and the contractor/grantee's name, with a publication date of 02/04/2022.