5-07 Worker Protection Form.pdf

PDF 70 KB Posted

Attached to
2026 Milling and Paving of Various Township Roads
Solicitation number
Not on record
Issued by
Montgomery County, Pennsylvania

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This is a Worker Protection and Investment Certification Form issued by the Commonwealth of Pennsylvania pursuant to Executive Order 2021-06, applicable to the SR 73, SEC. MT2 Skippack Pike and School Road Intersection Improvement Project in Whitpain Township, Montgomery County. The form requires contractors and grantees to certify compliance with Pennsylvania's labor and workplace safety laws, including the Unemployment Compensation Law, Workers' Compensation Law, Construction Workplace Misclassification Act, Employment of Minors Child Labor Act, Minimum Wage Act, Prevailing Wage Act, Equal Pay Law, and eleven additional state labor and workforce safety statutes. The certification must be executed by an authorized official of the contractor or grantee and submitted to the Township no later than January 22, 2026, at 11:00 AM. Sealed bids for the project are due via PennBid on Thursday, February 5, 2026, at 11:00 AM prevailing time, with the scope of work consisting of roadway widening, drainage system installation, traffic signal installation, stone masonry, traffic control, and signing and pavement marking installation.

Pennsylvania law establishes penalties for false certifications, including contract termination and three-year ineligibility to bid on Commonwealth contracts under 62 Pa. C.S. § 531. Contractors must report any change in compliance status to the Purchasing Agency immediately and understand that the certification is subject to penalties under 18 Pa. C.S. § 4904 for unsworn falsification to authorities. All proposals must be accompanied by a bid bond or certified check equal to 10% of the total bid price, issued by a surety licensed to do business in Pennsylvania. The successful bidder is required to furnish all payment, performance, and maintenance bonds as referenced in the bid documents, and no bid may be withdrawn within sixty days after opening.

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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: 02/04/2022

Name Printed:
Name PrintedRow1:
Title of Certifying Official PrintedRow1:

File details come from the government source that posted it. Updated .