Domestic Workforce Utilization Certification Form-Multiple Award.doc
DOC document 52 KB Posted
- Attached to
- D 11-2 Janitorial services for Beaver
- Solicitation number
- 6100065905
About this file
This is a Domestic Workforce Utilization Certification Form for multiple award contracts issued by the Commonwealth of Pennsylvania. The document serves as a certification requirement for suppliers bidding on state contracts and will be incorporated as a contractual obligation upon execution. Contractors must complete and sign the certification to receive evaluation consideration under this criterion, with failure to do so resulting in no points awarded for domestic workforce utilization. The certification evaluates each contractor's commitment to performing direct labor within the United States or within countries that are parties to the World Trade Organization Government Procurement Agreement, including nations such as Canada, the European Union member states, Japan, Korea, and the United Kingdom.
Contractors must select one of two certification options: either committing to perform all direct labor exclusively within the United States or eligible WTO countries, or specifying the percentage of direct labor to be performed in such locations and identifying which direct labor will be performed outside these boundaries and in which countries. Maximum evaluation consideration is awarded to suppliers committing to exclusive domestic or eligible international performance, while those proposing to perform direct labor outside the United States and outside WTO member countries receive correspondingly reduced scores. The certification requires the contractor's name, place of incorporation, address, and federal identification number, along with signatures from both the contractor representative and a witness or corporate officer. Any misstatement in the certification is treated as fraudulent concealment punishable under Pennsylvania Crimes Code Section 4904.
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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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