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
• Construction Project Waste Management Plan (sample)
• Contractor's Affidavit of Release of Liens
• Demolition Project Construction Waste Management Plan (sample)
• Diverse Business Utilization Report
• Schedule of Values
• Site Specific Safety Plan Template

• Change Order – AIA Form (sample)
• Change Order Breakdown Form after Nov. 1 – 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.

• Penn State Health Facilities Planning and Construction Contractor and Supplier Diversity Program

All contractors and staff must complete the virtual training within one year of their last training.  

Offsite training is required for all contractors and vendors who have never worked at Penn State Health or otherwise do not have a training certification card. Those contractors shall:  

• Watch the training video using the link below.  
• Complete the test via the QR code in the training or by clicking the link below.  

Visit the Facilities department on any Penn State Health Campus to receive your training certification card:

• Hershey Medical Center and Penn State College of Medicine: 90 Hope Drive, Academic Support Building, Suite 3301
• Hampden Medical Center: 2200 Good Hope Road Enola, ground floor, Room 0510
• Holy Spirit Medical Center: 503 N. 21st Street Camp Hill, basement, room B103
• Lancaster Medical Center: 2160 State Rd. Lancaster, first floor, room 1119
• St. Joseph Medical Center: 1036 MacArthur Rd. Reading, middle double doors

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 Test  

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.

• Penn State Health Federal COVID Compliance Survey for Employees, Contractors, Students and Volunteers
• COVID-19 Vaccination Exemption Form
• Penn State Health COVID-19 New Contract Addendum
• Penn State Health COVID-19 Notification of Stay Lifted
• Penn State Health COVID-19 Design and Construction Guidance

• Penn State Health Community Hospital Design Guidelines
• Penn State Health Information Services Standards for Construction (Room Standards)
• Information Technology Standards for Facilities Projects and Construction

• General Conditions of a Construction PO
• General Conduct of the Work and Special Requirements

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

• CPSL Disclosure Statement – Application for Employment, Including Provisional Employment 
• 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 – Interim Life Safety Measures (ILSM) for Fire System Maintenance, Life Safety Code Deficiencies and/or Construction/Renovation Projects
• 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
• HR11 – Sexual Harassment
• HR38 – Personal Behavior and Communication Standards
• HR46 – Substance Abuse/Drug-free Workplace
• HR68 Background Checks
• HR69 Tobacco Free Campus
• HR86 Complaints of Unlawful Discrimination or Harassment
• IC-015 – ICRA Policy for Penn State Health St. Joseph Medical Center
• ICRA – Penn State Health Lancaster Medical Center
• MP-01HPD – Safety Management Plan
• MP-01LMC – Safety Management Plan
• MP-01HSMC – Safety Management Plan
• MP-03HPD – Hazardous Materials and Waste Management Plan
• MP-03LMC – Hazardous Materials and Waste Management Plan
• MP-03HSMC – Hazardous Materials and Waste Management Plan
• MP-04HPD – Fire Safety Management Plan
• MP-04LMC – Fire Safety Management Plan
• MP-04HSMC – Fire Safety Management Plan
• PSHAM F-25 – Employee Business Travel Expense Reimbursement
• PRI-112 – Cybersecurity and Privacy
• S-05 HAM – Weapons Policy
• SA-11SPM – General Electrical Safety Requirements 
• 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
• SA-28SPM – Power Strips
• WS-IP-210 – ICRA Policy for Penn State Health Holy Spirit Medical Center and Hampden Medical Center
• WS-IP-210 - ICRA Policy – Attachment A for Penn State Health Holy Spirit Medical Center and Hampden Medical Center

• Patient Safety Risk Assessment

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: Form of Agreement 1-DB-GMP (Design-Build Guaranteed Max. Price Agreement (sample)
   

• Vizient Construction Program Supplier List

• Planning and Construction’s Contractor and Supplier Diversity Program – Penn State Health Facilities

Crystal A Campus 
100 Crystal A Drive, CA 132 
Hershey, PA 17033 

David J. Barto, PE, CHFM 
Vice President, Facilities 
Phone: 717-531-7266 

Catherine A. Brower
Director, Facilities Planning, Design and Construction 
Phone: 717-531-7266 

Mark D. Swank, LEED AP ID+C 
Director, Facilities and Services Administration 
Phone: 717-531-0003, x321463 

Charles Ulinfun, CHSP 
Director, Safety 
Phone: 717-531-6382 

Penn State Health Regional Directors 

Phillip Massey
Regional Director, Facilities 
East Region – Penn State Health Lancaster Medical Center and Penn State Health St. Joseph Medical Center 
Phone: 484-886-6442 

Jesse Myers 
Regional Director, Facilities 
West Region – Penn State Health Holy Spirit Medical Center and Penn State Health Hampden Medical Center  
Phone: 717-763-2495 

2200 Good Hope Road 
Enola, PA 17025 
 
Craig Blattenberger 
Facilities Supervisor 
Phone: 717-981-0510 

503 N. 21st Street 
Camp Hill, PA 17011 

Joshua Miller
Facilities Manager 
Phone: 717-763-2100 

2500 Bernville Road 
Reading, PA 19605 

Barry Angstadt
Director, Plant Operations 
Phone: 610-378-2109 

Paul Vincent 
Director, Ambulatory Facilities 
Phone: 717-531-0003, x320603