This government document is issued by Department of General Services for use in Pennsylvania
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https://www.google.com/url?client=internal-element-cse&cx=007572080359491747877:xg1tju_bfd4&q=https://www.dgs.pa.gov/Documents/Real%2520Estate%2520Forms/GSRE-42M%2520Contractor%2520Responsibility%2520Certification.pdf&sa=U&ved=2ahUKEwiYjcaHsbD-AhVBbKQEHcIbCcw4UBAWegQIARAB&usg=AOvVaw2X8EjcKVqkgW3p3-jc71ra