10-Workforce and Equal Pay Declaration Page.pdf

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Attached to
CHILLER REPAIR AND MAINTENANCE
Solicitation number
Solicitation201
Issued by
Ramsey County, Minnesota

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This is a Workforce and Equal Pay Declaration form required by the Minnesota Department of Human Rights for businesses executing government contracts with State or Metropolitan agencies, the University of Minnesota, or Political Subdivisions in Minnesota. The form applies to the Metropolitan Airports Commission's Request for Proposal for Chiller Service, Maintenance and Repairs at Minneapolis-St. Paul International Airport (MSP) and St. Paul Downtown Airport (STP). A mandatory pre-proposal meeting and site tour is scheduled for Monday, August 24, 2026, from 8:00 to 11:00 a.m. Bidders must complete this declaration form prior to contract execution.

The declaration form requires vendors to attest to their compliance with Minnesota's Workforce Certificate and Equal Pay Certificate requirements based on contract value thresholds. For Metropolitan agencies, a Workforce Certificate is required for contracts exceeding $100,000, and an Equal Pay Certificate is required for contracts exceeding $500,000. Vendors must indicate whether they hold current certificates, have applied for certificates, have not applied, or qualify for an exemption based on having fewer than 40 employees during the prior 12 months. Companies claiming exemption status must provide justification, which will be reviewed and determined by the Minnesota Department of Human Rights. The form requires vendor identification information, contracting agency name, and authorization by a company signatory. Questions regarding the form should be directed to the Minnesota Department of Human Rights Compliance at MDHR@state.mn.us.

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Workforce and Equal Pay Declarations Page Rev. 6/1/2023

Workforce and Equal Pay Declaration Page

This form is required for all businesses executing government contracts under the following:

Select one:

☐ Businesses executing a contract with State or Metropolitan agencies in excess of $100,000 (Workforce

Certificate) and, if applicable, $500,000 (Equal Pay Certificate)

☐ Businesses executing a contract with University of Minnesota for general obligation bond funded capital projects in excess of $100,000 (Workforce Certificate) and, if applicable, $500,000 (Equal Pay Certificate)

☐ Businesses executing a contract with Political Subdivisions for general obligation bond funded capital projects in excess of $250,000 (Workforce Certificate) and, if applicable, $1,000,000 (Equal Pay Certificate)

Select all that apply:

We are a certificate holder:

☐ Workforce Certificate under the name: _________________________________________________________ ☐ Equal Pay Certificate under the name: __________________________________________________________

We are applying/have applied for the following certificate(s):

☐ Workforce Certificate Application date (MM/DD/YYYY): ____________________ ☐ Equal Pay Certificate Application date (MM/DD/YYYY): ____________________

We have not applied for one or both certificates:

☐ Our company does not yet have a Workforce Certificate or Equal Pay Certificate. We acknowledge that a

Workforce Certificate and, if applicable, Equal Pay Certificate, or approved exemption by the Minnesota Department of Human Rights is required before a contract can be executed.

We are Exempt:

☐ We attest to the Minnesota Department of Human Rights that we have not employed 40 or more employees on a single day during the prior 12 months in Minnesota or the state in which we have our primary place of business. The Minnesota Department of Human Rights may request the names of our employees during the previous 12 months, the date of separation, if applicable, and the current employment status and count.

☐ We believe our company is exempt because ___________________________________________________.

The Minnesota Department of Human Rights will review and determine if your company is exempt.

Business Information

Vendor/Supplier ID Vendor Email

Business Name Name of Contracting Agency

Authorized Signatory Name Title Date

Signature Email Phone

For assistance with this form, email the Minnesota Department of Human Rights Compliance.MDHR@state.mn.us https://mn.gov/mdhr/certificates/workforce-certificate/ https://mn.gov/mdhr/certificates/workforce-certificate/ https://mn.gov/mdhr/certificates/equalpay/ https://mn.gov/mdhr/certificates/workforce-certificate/ https://mn.gov/mdhr/certificates/equalpay/ https://mn.gov/mdhr/certificates/workforce-certificate/ https://mn.gov/mdhr/certificates/equalpay/

Workforce and Equal Pay Declaration Page
Select one:
Select all that apply:
We are a certificate holder:
We are applying/have applied for the following certificate(s):
We have not applied for one or both certificates:
We are Exempt:

Business Information

State or Metropolitan agencies: On
University of Minnesota: Off
Political Subdivisions: Off
Vendor/Supplier ID:
Vendor Email:
Name of Contracting Agency:
Business Name:
Authorized Signatory Name:
Title:
Date:
Email:
Phone:
We are a Workforce Certificate holder: Off
We are a Equal Pay Certificate holder: Off
We are applying/have applied for a Workforce Certificate: Off
We are applying/have applied for a Equal Pay Certificate: Off
What is the application date of your Workforce Certificate?:
What is the application date of your Equal Pay Certificate?:
We have not applied for one or both certificates: Off
We have not employed 40 or more employees on a single day during the prior 12 months in Minnesota or the state in where we have our primary place of business: Off
We believe our company is exempt: Off
Why do you believe your company is exempt?:
What name is your Workforce Certificate under?:
What name is your Equal Pay Certificate under?:

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