Here you will find the documents needed for your Certificate of Payment (pay app) submission.

The Certificate of Payment Process Checklist is a list of all documents required for your pay app to be processed. Once you have completed your documents, you will need to send copies to the professional architect/engineer for your project and to Facilities Planning and Construction Accounting.

Please note that payments will be delayed if anything is missing or if the professional architect/engineer has not reviewed and signed off on the form. Carefully review these documents, and be sure they are shared with the individual(s) responsible for the assembly and submission of the Certificate of Payment package.

If you have any questions regarding the Certificate of Payment process, please contact Facilities Planning and Construction Accounting.

• Affidavit for Final Payment and Mechanics Lien
• Certificate of Payment Application
• Certificate of Payment Process Checklist
• Consent of Surety Company
• Construction Project Waste Management Plan (sample)
• Demolition Project Construction Waste Management Plan (sample)
• Diverse Business Utilization Report
• Penn State University OPP Contractor Safety Requirements – Appendix D Safety Information
• Schedule of Values
• Site Specific Safety Plan Template
• Steel Certificate Form
• Weekly Payroll Certification

• Change Order Summary and Cost Breakdown – To be used for contracts dated prior to Nov. 1, 2023.
• Change Order Breakdown form after Nov. 1, 2023 – The new change order breakdown form and revised change order language will be effective on contracts executed after Nov. 1, 2023. The new breakdown form and language modernizes the overall change order process, aligns Penn State Health with peer institutions and creates efficiencies and time savings.

The links below provide consolidated COVID-19 guidance developed for design and construction projects. These COVID-19 guidelines apply to all third-party construction managers, contractors, subcontractors, design professionals, suppliers and consultants who conduct work on the campus of Penn State Health Milton S. Hershey Medical Center and Penn State College of Medicine in furtherance of design and construction projects and is inclusive of all Penn State Health campuses.

• Federal COVID-19 Compliance Survey for Employees, Contractors, Students and Volunteers
• COVID-19 Bulletin – Feb. 7, 2022
• Penn State Health COVID-19 Notification Requirement
• Design and Construction COVID-19 Guidance
• COVID-19 Pandemic Impacts Addendum – New Contract
• COVID-19 Vaccination Exemption

• Design Construction Guidelines – Penn State Health Milton S. Hershey Medical Center and Penn State College of Medicine
  • Hershey Medical Center Suspended Ceiling Guide 
  • A09A – Penn State Health Exterior Wayfinding and Signage Standards Manual
  • A09B Penn State Health Interior Wayfinding and Signage Standards Manual
  • A13 – Penn State Health Artwork and Photography Standards
  • A14 – Penn State Health Furniture Specifications
  • A16 – Hershey Medical Center Equipment Data Acquisition Form
  • A17 – Standard Paving Details
  • Sample Specification for Limestone Cladding Maintenance/Repair
  • Pavement Markings 
  • Pavement Restoration – Section G Specification
  • Penn State Health Marketing and Branding Photography Image Bank and Mission Images
• Penn State Health Information Services Standards for Construction (Room Standards)
• Information Technology Standards for Facilities Projects and Construction
• Penn State University Minimum Standards for Telecommunications Facilities
   

• General Conduct of the Work and Special Requirements
• Notification of Contract Requirements Pertaining to the Prevailing Wage Act
• Terms and Conditions for Projects Under $500,000

Effective January 1, 2022 until further notice 

In accordance with state and federal recommendations to reduce the spread of the coronavirus and COVID-19, all in-person Safety and Infection Control Risk Assessment (ICRA) training sessions are cancelled until further notice. All contractors and staff must complete the virtual training within one year of their last training.  

Offsite training is still required for all contractors who have never worked on the Penn State Health Milton S. Hershey Medical Center campus or otherwise do not have a training certification card. Those contractors shall:  

• Watch the training video using the link below.  
• Download the documentation that includes the certification test at the link below.  
• Complete the test. Verify that your name and company name are on the top of each page of the test.  
• Scan and email the completed test to [email protected].
• Visit Facilities on the Hershey Medical Center campus at 90 Hope Drive, Academic Support Building, Suite 3301, and receive your training certification card. Please allow 48 hours to process the documentation following submission of your test.  

Training resources:

• Safety and ICRA Training Video
• Contractor and Vendor Safety and ICRA Training Orientation Packet and Test

• After Hours Emergency Calls
• Change Order Summary and Cost Breakdown
• Confined Space Permit
• Contractor Shutdown Request
• Federal Clean Air Act Form
• Lead-Free Plumbing Material Certification
• Medical Gas Shutdown Checklist
• Regulations and Procedures for Contracts

As a contractor for Penn State Health, you are required to follow the policies listed below.

• A-65 – Visitors, Admission to Operating Room Suite
• 40-16 – Water Incursion Check List Procedure
• A-72 HAM – Two-Way Radio and Cell Phone Usage
• A-96 HAM – Above Ceiling Compliance
• DE-01SPM – Safety Management Plan
• DE-03SPM – Hazardous Materials and Waste Management Plan
• DE-05SPM – Fire Safety Management Plan
• EH-22 Seasonal (Influenza) and other Viral Respiratory Illness Policy for Workforce
• FP-04SPM – Safety Requirements for Contractors and Vendors
• FP-05SPM – Furnishings and Interior Finishes
• FP-06SPM – Hot Work Permit 
• FP-07SPM – ILSM
• FP-08SPM – Fire Alarm Detection Sprinkler Systems Fire Pumps Out of Service
• FP-09SPM – Means of Egress Use and Maintenance
• FP-15SPM – Safety Requirements for Vendor Representatives
• FP-22SPM – Above Ceiling Compliance Policy 
• HM-01SPM– Asbestos Management and Control
• HM-03SPM – Compressed Gas Cylinders
• HR11 – Sexual Harassment
• HR38 – Personal Behavior and Communication Standards
• HR46 – Substance Abuse/Drug-free Workplace
• HR68 – Background Checks – Penn State Health
• HR69 – Tobacco Free Campus
• HR85 – Background Checks – Penn State College of Medicine
• HR86 – Complaints of Unlawful Discrimination or Harassment
• III-14 – Construction, Renovation, and Maintenance Infection Control Program
• CPSL Disclosure Statement – Application for Employment, Including Provisional Employment 
• PRI-112 – Cybersecurity and Privacy
• PSHAM F-42 – Employee Business Expenses
• S-05 HAM – Weapons Policy 
• SA-06SPM – Confined Space Entry
• SA-11SPM – General Electrical Safety Requirements
• SA-12SPM – Power Strips
• SA-13SPM – Fall Protection
• SA-16SPM – Lock-out and Tag-out
• SA-19SPM – Ladder Safety
• SA-20SPM – Personal Protective Equipment
• SA-22SPM – Management of the Environment During Construction, Renovation and Demolition
• SA-25SPM – Machine Guarding

Professional Agreements

• Form of Agreement 1-S: Short version form of the Owner-Professional agreement. It is used for limited professional services. For example, a feasibility study.
• Form of Agreement 1-P: Long version form of the Owner-Professional agreement. It is used for full design services.

Construction Manager Agreements

• 1-CM-GMP General Conditions: General Conditions of the 1-CM-GMP agreement
• Form of Agreement 1-CM-GMP: Construction Manager Guaranteed Max. Price Agreement (sample)

Construction Contractor Agreements

• Form of Agreement 1-C (sample)
• General Conditions of the Contract (sample)

Design Build Agreements

• Form of Agreement 1-DB-GMP: Design-Build Guaranteed Max. Price Agreement (sample)
• Building Information Modeling (BIM) Universal Addendum

DGS Construction Contractor Agreements

• 1-C DGS Agreement
• 1-C DGS General Conditions

The spotted lanternfly is an invasive insect that has spread throughout southeastern Pennsylvania since its discovery in Berks County in 2014. This insect has the potential to greatly impact agricultural crops in Pennsylvania, including grapes, hops and hardwoods. It is also reducing the quality of life for people living in heavily infested areas. Penn State’s College of Agricultural Sciences, the United States Department of Agriculture and the Pennsylvania Department of Agriculture (PDA) have joined forces to control and contain the spread of the spotted lanternfly. To help slow its spread, the PDA implemented a Spotted Lanternfly Order of Quarantine and Treatment on May 26, 2018. The quarantine is a Pennsylvania law. 

This order applies to all businesses that travel within, into or out of the quarantine zone, including the Milton S. Hershey Medical Center and Penn State College of Medicine. Therefore, as employees of Hershey Medical Center and the College of Medicine, we need to comply with the order for the following reasons: 

1. It is the law in Pennsylvania. 
2. The Hershey Medical Center and College of Medicine campus is located within the quarantine zone. 
3. Penn State is in support of this program. Penn State College of Agricultural Sciences is assisting the state with this effort, and we should support our colleagues’ efforts. 
4. The spotted lanternfly can quickly decimate hardwoods; fruit trees, including grapes and hops; and nurseries. Pennsylvania is a major producer and exporter in these industries and the economic impact may be great if not controlled. 
5. People not complying can receive a ticket and fine from the police.

• Pennsylvania Department of Agriculture Order of Quarantine and Treatment: Spotted Lanternfly
• Spotted Lanternfly Business Toolkit
• Spotted Lanternfly Order or Quarantine and Treatment
• Spotted Lanternfly Designated Employee Annual Self-Audit
• Spotted Lanternfly Quarantine Requirement Implementation Procedures
• Spotted Lanternfly Quarantine Implementation Worksheet
• Spotted Lanternfly Quarantine Zone Map
• Spotted Lanternfly Training for Drivers Acknowledgement
• Spotted Lanternfly Vehicle Inspection Report

• Contractor Parking Map

• Vizient Construction Program Supplier List