2026-803_Workforce_and_Equal_Pay_Declaration_Form.pdf
PDF 178 KB Posted
- Solicitation number
- 2000018194
- Issued by
- Cass County, Mower County, Minnesota
About this file
This is a Workforce and Equal Pay Declaration Form required by the Minnesota Department of Human Rights for businesses executing government contracts with state, local, and university entities. The form applies to contracts exceeding specified thresholds: $100,000 with state or metropolitan agencies for Workforce Certificates (and $500,000 for Equal Pay Certificates), $100,000 with University of Minnesota for general obligation bond-funded capital projects (and $500,000 for Equal Pay Certificates), and $250,000 with political subdivisions for general obligation bond-funded capital projects (and $1,000,000 for Equal Pay Certificates). Contractors must complete Part 1 by selecting one of four options: certifying they hold current Workforce and/or Equal Pay Certificates, indicating they have applied for these certificates with specified application dates, acknowledging they have not yet applied and recognizing that certification or approved exemption is required before contract execution, or attesting to exemption status based on not employing 40 or more employees on a single day during the prior 12 months in Minnesota or their primary place of business.
Part 2 requires completion of standard business information fields including vendor/supplier identification number, business name, contracting agency name, authorized signatory details, date, signature, email, and phone number. Contractors selecting the exemption option in Part 1.04 must attest that the Minnesota Department of Human Rights may request documentation of employee names, separation dates, and current employment status to verify the 40-employee threshold has not been met. Completed forms should be directed to the Minnesota Department of Human Rights Compliance office for processing and certification verification.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 2026-803_EVENT_Specifications.pdf | ||
| 2026-803_Qualification_Form_Bid_Group_2.pdf | ||
| 2026-803_Price_Schedule.xlsx | XLSX spreadsheet | |
| DNR_RFB_Cass_and_Mille_Lacs_Counties_Forest_Stand.pdf | ||
| 2026-803_Qualification_Form_Bid_Group_1.pdf |
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Text version
PRIME CONTRACTOR RESPONSE FORM
Workforce and Equal Pay Declaration Page
This form is required for all businesses executing government contracts under the following:
PART 1 - SELECT ALL THAT APPLY:
1.01 WE ARE A CERTIFICATE HOLDER:
☐ Workforce Certificate under the name:
☐ Equal Pay Certificate under the name:
1.02 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):
1.03 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.
1.04 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 where 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.
PART 2 - BUSINESS INFORMATION
Vendor/Supplier ID 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
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 mailto: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/equalpay/ https://mn.gov/mdhr/certificates/workforce-certificate/ https://mn.gov/mdhr/certificates/equalpay/ https://mn.gov/mdhr/certificates/equalpay/
| PART 1 - Select all that apply: |
| 1.01 We are a certificate holder: |
| 1.02 We are applying/have applied for the following certificate(s): |
| 1.03 We have not applied for one or both certificates: |
| 1.04 We are Exempt: |
PART 2 - Business Information
File details come from the government source that posted it. Updated .