DomesticWorkforceUtilizationCertificationForm_MultipleAward.pdf
PDF 129 KB Posted
- Attached to
- District 3 Uniform/Shop Towel Rental
- Solicitation number
- 6100066544
- Issued by
- Lycoming County, 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 3 Uniform/Shop Towel Rental procurement for the Pennsylvania Department of Transportation (PennDOT). The form establishes certification requirements for contractors bidding on uniform rental and laundering services across PennDOT Engineering Districts 3-5 (Snyder County), 3-8 (Union County), and 3-4 (Northumberland County). The certification will be used as an evaluation criterion in the best value selection process for each assignment, with maximum consideration given to suppliers committing to perform contracted direct labor exclusively within the United States or within countries that are parties to the World Trade Organization Government Procurement Agreement.
Contractors must complete and sign the certification form to receive consideration under this criterion, and failure to do so results in no score for this evaluation element. Contractors must certify either that one hundred percent of direct labor will be performed domestically or within eligible WTO Government Procurement Agreement countries, or specify a particular percentage with identification of the country where labor will be performed outside these approved boundaries. The form lists forty-two eligible countries including Canada, European Union member states, Japan, Korea, New Zealand, Israel, and others. Any misstatement on the certification is treated as fraudulent concealment under Section 4904 of the Pennsylvania Crimes Code and is contractually binding upon execution of the award.
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Text version
BOP-1301.Multiple Award
Revised 02/23/2018
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
BOP-1301.Multiple Award
Revised 02/23/2018
Printed Name/Title Printed Name/Title
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