Domestic Utilization Form (1).pdf
PDF 155 KB Posted
- Attached to
- Susq/Wyom Secondary Herbicide Services State and local contract opportunity
- Solicitation number
- 6100065047
- Issued by
- Lackawanna 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. The document applies to the Susquehanna and Wyoming County Roads secondary herbicide services contract, which involves roadside pesticide and herbicide spraying services performed in accordance with PennDOT's Maintenance Manual standards.
The certification requires offerors to commit to using domestic workforce in contract fulfillment and to indicate the percentage of direct labor that will be performed within the United States or within countries that are parties to the World Trade Organization Government Procurement Agreement. Offerors must select one of two options: certify that all direct labor will be performed exclusively within the United States or qualifying WTO countries, or specify the exact percentage of direct labor to be performed in these approved geographical boundaries and identify any direct labor to be performed outside these areas, including the specific country. The form must be completed, signed, and attested by authorized representatives of the contracting entity and will become a contractual obligation upon contract execution. The Department of General Services treats any misstatement on this certification as fraudulent concealment under Section 4904 of the Pennsylvania Crimes Code, Title 18. Failure to complete and sign the certification will disqualify the offeror from receiving any consideration under this scoring criterion.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| OS-501 (1) (4).pdf | ||
| 2026 Susquehanna and Wyoming Secondary Herbicide Contract Specs_FINAL PDF.pdf | ||
| Trade Secret Form (2).pdf | ||
| Worker Protection and Investment Cert Form (BOP 2201).docx | DOCX document | |
| Terms and Conditions Suq.pdf |
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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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