Appendix E - Worker Protection and Investment Certification Form.pdf

The document is a Worker Protection and Investment Certification Form issued by the Commonwealth of Pennsylvania pursuant to Executive Order 2021-06, dated October 21, 2021. The form requires contractors and grantees to certify compliance with Pennsylvania's labor laws and workplace safety regulations, including 13 specific state labor statutes such as the Construction Workplace Misclassification Act, Employment of Minors Child Labor Act, Minimum Wage Act, Prevailing Wage Act, and others related to employment practices.

The certification form mandates that contractors attest to being duly authorized to execute the document on behalf of their organization and confirm full compliance with all applicable Pennsylvania state labor and workplace safety laws. The document outlines potential penalties for providing false certifications, including contract termination and a three-year ineligibility to bid on contracts under 62 Pa. C.S. § 531. The form requires the signature, printed name, title, and organization of the certifying official, and was published on 02/07/2022.