WORKER PROTECTION AND INVESTMENT CERTIFICATION FORM.pdf

The document is a Worker Protection and Investment Certification Form issued by the Commonwealth of Pennsylvania, specifically tied to Executive Order 2021-06. The form requires contractors and grantees working in Pennsylvania to certify compliance with 13 different state labor and workforce safety laws, including the Construction Workplace Misclassification Act, Employment of Minors Child Labor Act, Minimum Wage Act, Prevailing Wage Act, and several other labor-related statutes.

The certification form mandates that contractors affirm they are following Pennsylvania's labor regulations and understand potential penalties for non-compliance, which can include contract termination and three-year ineligibility to bid on contracts. By signing the document, the contractor/grantee acknowledges their responsibility to immediately report any changes in compliance status to the Purchasing Agency and confirms understanding that false certifications are subject to legal penalties under 18 P.A. C.S. § 4904.