Domestic Utilization Form (1).pdf
PDF 155 KB Posted
- Attached to
- Luzerne Secondary Herbicide Services
- Solicitation number
- 6100065045
- Issued by
- Luzerne County, Pennsylvania
About this file
This is a Domestic Workforce Utilization Certification form required by the Commonwealth of Pennsylvania for state and local contract opportunities, specifically applicable to the Luzerne County Secondary Herbicide Services contract. The form establishes scoring criteria based on contractors' commitment to utilize domestic workforce in fulfilling contracted direct labor obligations. Offerors must certify the percentage of direct labor to be performed within the United States or within countries that are parties to the World Trade Organization Government Procurement Agreement, including nations such as Canada, Japan, the United Kingdom, and numerous European Union members. Maximum scoring consideration is awarded to contractors who commit to performing all direct labor exclusively within approved geographical boundaries, while those proposing to perform labor outside the United States and outside WTO Government Procurement Agreement member countries receive proportionally reduced scores based on the percentage of non-compliant labor.
Completion and signature of this certification form is mandatory for offerors to receive any consideration under this evaluation criterion, and failure to complete the certification results in zero points awarded for domestic utilization. Contractors must identify the specific percentage of direct labor performed within approved territories and must disclose any direct labor to be performed outside the United States and non-WTO member countries, including the country locations where such work will occur. The Commonwealth of Pennsylvania treats any misstatement on this form as fraudulent concealment punishable under Section 4904 of the Pennsylvania Crimes Code, and the completed certification becomes a contractual obligation upon contract execution. The form requires attestation by corporate officers and must be signed and dated by authorized representatives of the contracting entity.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Trade Secret Form (2).pdf | ||
| OS-501 (1) (4).pdf | ||
| 2026 Luzerne Secondary Herbicide Contract Specs_FINAL PDF.pdf | ||
| Terms and Conditions Luzern.pdf | ||
| Worker Protection and Investment Cert Form (BOP 2201).docx | DOCX document |
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Text version
APPENDIX B
DOMESTIC WORKFORCE UTILIZATION CERTIFICATION
To the extent permitted by the laws and treaties of the United States, each proposal will be scored for its commitment to use the domestic workforce in the fulfillment of the contract. Maximum consideration will be given to those offerors 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, offerors 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 offeror for this criterion.
I, ______________________[title] of ____________________________________[name of Contractor] a _______________ [place of incorporation] corporation or other legal entity, (“Contractor”) located at __________________________________________________________ [address], having a Social Security or Federal Identification Number of ________________________, 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, Aruba, Austria, Belgium, Bulgaria, Canada, Chinese Taipei, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hong Kong, Hungary, Iceland, Ireland, Israel, Italy, Japan, Korea, Latvia, Liechtenstein, Lithuania, Luxemburg, Malta, the Netherlands, Norway, Poland, Portugal, Romania, Singapore, Slovak Republic, Slovenia, Spain, Sweden, Switzerland, 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
Printed Name/Title Printed Name/Title
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