10 DomesticWorkforceUtilizationCertificationForm_MultipleAward.docx
DOCX document 46 KB Posted
- Attached to
- 12 OVR Enhanced Driving and Ancillary Services
- Solicitation number
- 6100059505
- Issued by
- Carbon County, Dauphin County, York County, Wolfdale CDP, Pennsylvania
About this file
This document is a Domestic Workforce Utilization Certification form for a multiple award state contract opportunity. The Commonwealth of Pennsylvania is seeking suppliers to certify the extent to which they will use a domestic workforce to fulfill the contracted direct labor. Suppliers must indicate whether 100% of the direct labor will be performed within the United States or a World Trade Organization member country, or specify the percentage of direct labor that will be performed domestically. Suppliers must also identify any direct labor that will be performed outside the United States and not within a World Trade Organization member country. Failure to complete this certification will result in no consideration for this criterion.
The related state and local contract opportunity is for the Pennsylvania Department of Labor and Industry, Office of Vocational Rehabilitation to procure professional, on-demand Non-Emergency Business Transport Services. The services are required for the 21 District offices of the Bureau of Vocational Rehabilitation Services and the Bureau of Blind and Visual Services located throughout the Commonwealth. The services include both ambulatory and non-ambulatory transports, as well as ancillary services such as scribe work, sighted guide, and safety surveys. Suppliers must register as a small business and meet all applicable local, state, and federal requirements. The contract will be awarded on a best value basis, with maximum consideration given to suppliers committing to use a domestic workforce.
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DOMESTIC WORKFORCE UTILIZATION CERTIFICATION FOR MULTIPLE AWARD CONTRACTS
To the extent permitted by the laws and treaties of the United States, this certification will be used by the Agency in making a best value selection for each particular assignment. Each quote will be evaluated for its commitment to use the domestic workforce in the fulfillment of the contract. Maximum consideration will be given to those suppliers who will perform the contracted direct labor exclusively within the geographical boundaries of the United States or within the geographical boundaries of a country that is a party to the World Trade Organization Government Procurement Agreement. Those who propose to perform a portion of the direct labor outside of the United States and not within the geographical boundaries of a party to the World Trade Organization Government Procurement Agreement will receive a correspondingly smaller score for this criterion. In order to be eligible for any consideration for this criterion, suppliers must complete and sign the following certification. This certification will be included as a contractual obligation when the contract is executed. Failure to complete and sign this certification will result in no consideration being given to the supplier for this criterion.
I, ______________________[title] of ____________________________________[name of Contractor] a _______________ [place of incorporation] corporation or other legal entity, (“Contractor”) located at ________________________________________________________________ [address], do hereby certify and represent to the Commonwealth of Pennsylvania (“Commonwealth”) (Check one of the boxes below):
|_| All of the direct labor performed within the scope of services under the contract will be performed exclusively within the geographical boundaries of the United States or one of the following countries that is a party to the World Trade Organization Government Procurement Agreement: Armenia, Netherland with respect to Aruba, Australia, Austria, Belgium, Bulgaria, Canada, Chinese Taipei, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hong Kong China, Hungary, Iceland, Ireland, Israel, Italy, Japan, Korea Republic of, Latvia, Liechtenstein, Lithuania, Luxemburg, Malta, Moldovia Republic of, Montenegro, New Zealand, the Netherlands, Norway, Poland, Portugal, Romania, Singapore, Slovak Republic, Slovenia, Spain, Sweden, Switzerland, Ukraine and the United Kingdom.
OR
|_| ________________ percent (_____%) [Contractor must specify the percentage] of the direct labor performed within the scope of services under the contract will be performed within the geographical boundaries of the United States or within the geographical boundaries of one of the countries listed above that is a party to the World Trade Organization Government Procurement Agreement. Please identify the direct labor performed under the contract that will be performed outside the United States and not within the geographical boundaries of a party to the World Trade Organization Government Procurement Agreement and identify the country where the direct labor will be performed:
[Use additional sheets if necessary]
The Department of General Services [or other purchasing agency] shall treat any misstatement as fraudulent concealment of the true facts punishable under Section 4904 of the Pennsylvania Crimes Code, Title 18, of Pa. Consolidated Statutes.
| Attest or Witness: | ______________________________ | |
| Corporate or Legal Entity’s Name |
| _____________________________ | ______________________________ | |
| Signature/Date | Signature/Date |
| _____________________________ | ______________________________ | |
| Printed Name/Title | Printed Name/Title |
BOP-1301.Multiple Award Revised 02/23/2018
File details come from the government source that posted it. Updated .