Worker Protection Form .docx
DOCX document 32 KB Posted
- Attached to
- 23WHM SGL62 Fuel Tank Storage
- Solicitation number
- 6100064643
- Issued by
- Lycoming County, Pennsylvania
About this file
The document is a Worker Protection and Investment Certification Form issued by the Commonwealth of Pennsylvania. The form requires contractors and grantees to certify compliance with various state labor and workforce safety laws, including acts related to workplace misclassification, employment of minors, minimum wage, prevailing wage, equal pay, and other labor regulations. The certification is mandatory under Executive Order 2021-06 and requires authorized officials to attest to their organization's adherence to Pennsylvania's labor standards.
The certification form includes significant legal implications for non-compliance, with potential penalties including contract termination and a three-year debarment from bidding on Commonwealth contracts. Contractors must sign and affirm their compliance, understanding that false certification can result in legal consequences under 18 Pa. C.S. § 4904 for unsworn falsification to authorities. The form was published on 02/07/2022 and requires the printed name, title, and signature of an authorized representative of the contractor or grantee, along with the date of certification.
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Text version
WORKER PROTECTION AND INVESTMENT CERTIFICATION FORM
A. Pursuant to Executive Order 2021-06, Worker Protection and Investment (October 21, 2021), the Commonwealth is responsible for ensuring that every worker in Pennsylvania has a safe and healthy work environment and the protections afforded them through labor laws. To that end, contractors and grantees of the Commonwealth must certify that they are in compliance with Pennsylvania’s Unemployment Compensation Law, Workers’ Compensation Law, and all applicable Pennsylvania state labor and workforce safety laws including, but not limited to:
1. Construction Workplace Misclassification Act
2. Employment of Minors Child Labor Act
3. Minimum Wage Act
4. Prevailing Wage Act
5. Equal Pay Law
6. Employer to Pay Employment Medical Examination Fee Act
7. Seasonal Farm Labor Act
8. Wage Payment and Collection Law
9. Industrial Homework Law
10. Construction Industry Employee Verification Act
11. Act 102: Prohibition on Excessive Overtime in Healthcare
12. Apprenticeship and Training Act
13. Inspection of Employment Records Law
B. Pennsylvania law establishes penalties for providing false certifications, including contract termination; and three-year ineligibility to bid on contracts under 62 Pa. C.S. § 531 (Debarment or suspension).
CERTIFICATION
I, the official named below, certify I am duly authorized to execute this certification on behalf of the contractor/grantee identified below, and certify that the contractor/grantee identified below is compliant with applicable Pennsylvania state labor and workplace safety laws, including, but not limited to, those listed in Paragraph A, above. I understand that I must report any change in the contractor/grantee’s compliance status to the Purchasing Agency immediately. I further confirm and understand that this Certification is subject to the provisions and penalties of 18 Pa. C.S. § 4904 (Unsworn falsification to authorities).
| Signature |
| Date |
Name (Printed)
Title of Certifying Official (Printed)
Contractor/Grantee Name (Printed)
BOP-2201
Published: 02/07/2022 image1.png
File details come from the government source that posted it. Updated .