06. Worker Protection Form.docx
DOCX document 32 KB Posted
- Attached to
- Tioga FD-16 DSA Colton Road
- Solicitation number
- 6100063922-1
- Issued by
- Warren County, Pennsylvania
About this file
The document is a Worker Protection and Investment Certification Form issued by the Commonwealth of Pennsylvania, mandated by Executive Order 2021-06. The form requires contractors and grantees to certify compliance with various state labor and workforce safety laws, including acts related to workplace misclassification, employment of minors, minimum wage, prevailing wage, equal pay, and other labor protections. Contractors must affirm adherence to 13 specific labor regulations and understand that false certifications can result in contract termination and a three-year prohibition from bidding on state contracts.
The certification form emphasizes legal accountability, with signatories acknowledging potential penalties under 18 Pa. C.S. § 4904 for providing false information. Contractors must immediately report any changes in their compliance status to the purchasing agency. The form serves as a critical mechanism for the Commonwealth to ensure worker safety, fair labor practices, and regulatory compliance across state-funded projects and contracts. Signatures, printed names, titles, and contractor names are required to validate the certification.
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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: 02/07/2022 image1.png
File details come from the government source that posted it. Updated .