Domestic Workforce Utilization Certification Form-Multiple Award (1).doc
DOC document 33 KB Posted
- Attached to
- District 5 I-78 Warning Gates
- Solicitation number
- 6100066744
- Issued by
- Lehigh County, Allentown City, Pennsylvania
About this file
This is a Domestic Workforce Utilization Certification Form for Multiple Award Contracts issued by the Commonwealth of Pennsylvania, Department of General Services, applicable to the District 5 I-78 Warning Gates repair and maintenance project in Berks and Lehigh counties. The certification form is a contractual requirement that evaluates contractor commitments to utilize domestic workforce in contract fulfillment. Contractors must complete and sign the certification to receive consideration under this evaluation criterion, with maximum consideration given to suppliers performing all direct labor exclusively within the United States or within countries that are parties to the World Trade Organization Government Procurement Agreement. Failure to complete and sign the certification results in no consideration for this criterion during the best value selection process for individual assignments.
The form requires contractors to certify either that 100 percent of direct labor will be performed within acceptable geographical boundaries, or to specify a percentage of direct labor to be performed domestically and identify any work to be performed outside the United States and outside WTO Government Procurement Agreement member countries. Misstatements on the certification are treated as fraudulent concealment punishable under Section 4904 of the Pennsylvania Crimes Code. The certification becomes a binding contractual obligation upon contract execution and must be attested by authorized representatives of the contractor's corporate or legal entity.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| D5 Warning Gate Location Map Blueprint Drawings.pdf | ||
| Terms and Conditions.pdf | ||
| OS-52.pdf | ||
| D5 I-78 Warning Gates SOW.doc | DOC document | |
| OS-501.pdf | ||
| Attachment A - Gate and Guiderail Coordinates.pdf | ||
| Attatchment B - Worker Protection Agency Form BOP-2201.docx | DOCX document | |
| Iran Free Procurement Certification Form.pdf | ||
| TradeSecret Form.pdf | ||
| Roadside Activity Report (M-609).pdf |
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Text version
DOMESTIC WORKFORCE UTILIZATION CERTIFICATION FOR MULTIPLE AWARD CONTRACTS
To the extent permitted by the laws and treaties of the United States, this certification will be used by the Agency in making a best value selection for each particular assignment. Each quote will be evaluated for its commitment to use the domestic workforce in the fulfillment of the contract. Maximum consideration will be given to those suppliers 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, suppliers 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 supplier 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):
FORMCHECKBOX
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
FORMCHECKBOX
________________ 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
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