WORKER PROTECTION AND INVESTMENT CERTIFICATION FORM.pdf

This is a Worker Protection and Investment Certification Form issued by the Commonwealth of Pennsylvania under Executive Order 2021-06, dated October 21, 2021. The document requires contractors, grantees, and vendors working in Pennsylvania to certify compliance with 13 specific 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 others.

The form mandates that contractors and grantees affirm they are adhering to Pennsylvania's labor regulations, with potential penalties for false certifications including contract termination and a three-year prohibition on bidding for contracts. The certification requires an authorized official to sign, confirming compliance and understanding that any changes in compliance status must be immediately reported to the Purchasing Agency. The document was published on 02/07/2022 and includes blank fields for signature, name, title, and contractor/grantee information.