DomesticWorkforceUtilizationCertificationForm_MultipleAward.doc
DOC document 47 KB Posted
- Attached to
- Low-Income Tax Clinic SouthWest
- Solicitation number
- 6100066332
- Issued by
- Dauphin County, Harveys Lake Borough, 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, in connection with a Low-Income Tax Clinic contract opportunity in Southwest Pennsylvania. The certification is a mandatory document that contractors must complete and sign to receive consideration under the domestic workforce utilization evaluation criterion. Contractors must certify either that all direct labor will be performed exclusively within the United States or within countries party to the World Trade Organization Government Procurement Agreement, or specify the percentage of direct labor to be performed in eligible locations and identify any work performed outside these boundaries. The form requires contractors to provide their legal entity information, location, and specific details regarding labor allocation geographically.
Completion and signature of this certification is a contractual obligation upon execution of the agreement, and failure to submit the form results in no consideration for the domestic workforce criterion during best value selection. The Commonwealth treats any misstatement on the certification as fraudulent concealment punishable under Pennsylvania Crimes Code Section 4904. The eligible countries for workforce utilization include Canada, members of the European Union, and other World Trade Organization Government Procurement Agreement signatories such as Israel, Japan, Korea, New Zealand, Singapore, and Switzerland. Contractors must attest to their statements with signatures from both the contractor and a corporate or legal entity representative, including printed names and titles.
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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], 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, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hong Kong, Hungary, Iceland, Ireland, Israel, Italy, Japan, Korea, Latvia, Liechtenstein, Lithuania, Luxemburg, Malta, Moldovia, Montenegro, New Zealand, the Netherlands, Norway, Poland, Portugal, Romania, Singapore, Slovak Republic, Slovenia, Spain, Sweden, Switzerland, Ukraine 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 BOP-1301.Multiple Award
Revised 02/23/2018
File details come from the government source that posted it. Updated .