Appendix F - Worker Protection and Investment Certification Form.pdf

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Attached to
Family Support Programs
Solicitation number
25-RFA-13800
Issued by
Pennsylvania

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This is a Worker Protection and Investment Certification Form issued by the Commonwealth of Pennsylvania in compliance with Executive Order 2021-06, applicable to contractors and grantees working with the Department's Office of Child Development and Early Learning (OCDEL), Bureau of Early Intervention Services and Family Supports on Family Support Programs. The form requires that all contractors and grantees certify compliance with Pennsylvania's Unemployment Compensation Law, Workers' Compensation Law, and applicable state labor and workforce safety laws, including but not limited to the Construction Workplace Misclassification Act, Employment of Minors Child Labor Act, Minimum Wage Act, Prevailing Wage Act, Equal Pay Law, Employer to Pay Employment Medical Examination Fee Act, Seasonal Farm Labor Act, Wage Payment and Collection Law, Industrial Homework Law, Construction Industry Employee Verification Act, Act 102 regarding excessive overtime in healthcare, Apprenticeship and Training Act, and Inspection of Employment Records Law. The certification must be executed by an official duly authorized to bind the contractor or grantee and must be submitted as part of the proposal or application process.

The certification form imposes significant compliance obligations and legal consequences for false statements. Contractors and grantees must certify their compliance status at the time of submission and are required to immediately report any changes in compliance status to the Purchasing Agency. Pennsylvania law establishes penalties for providing false certifications, including contract termination and three-year ineligibility to bid on Commonwealth contracts under 62 Pa. C.S. 531 (Debarment or Suspension). Additionally, false certifications are subject to criminal penalties under 18 Pa. C.S. 4904 (Unsworn Falsification to Authorities). The form was published on February 7, 2022, and serves as a mandatory component of the application requirements for Family Support Programs funding, which aims to support Evidence Based Home Visiting programs across Pennsylvania's 67 counties.

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APPENDIX F

Workers Protection and Investment Certification Form

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

Appendix A - Proposal Cover Sheet
Appendix A - Application Cover Sheet
BOP-2201 EO 2021-06 Worker Protection Form BOP 02072022 FINAL.pdf
WORKER PROTECTION AND INVESTMENT CERTIFICATION FORM
CERTIFICATION

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