2026-908_Workforce___Equal_Pay_Declaration_Form.pdf
PDF 178 KB Posted
- Attached to
- DNR RFB Rice County Observation Well Drilling
- Solicitation number
- 2000018303
- Issued by
- Scott County, Minnesota
About this file
This is a Workforce and Equal Pay Declaration Form required by the Minnesota Department of Human Rights for prime contractors executing government contracts with Minnesota state, local, and university entities. The form applies to businesses entering contracts with State or Metropolitan agencies exceeding $100,000 (Workforce Certificate) and $500,000 (Equal Pay Certificate), University of Minnesota for general obligation bond-funded capital projects exceeding $100,000 and $500,000 respectively, or Political Subdivisions for general obligation bond-funded capital projects exceeding $250,000 and $1,000,000 respectively. The specific contract opportunity is the Rice County Observation Well Drilling project (RFB 2026-908) with the Minnesota Department of Natural Resources, which involves labor, equipment, materials, tools, and transportation necessary to install and complete two groundwater observation wells in Rice County at Sunktokeca Creek WMA near Faribault. Responses must be submitted electronically through the Swift Portal with all attachments reviewed and requirements met; site visits can be arranged by contacting Project Supervisor Stephen Labuz at 651-295-3390, and contractor assistance is available at 651-201-8100, Option 1.
Contractors must declare their certification status under one of four options: holding current Workforce and/or Equal Pay Certificates, applying for such certificates with specified application dates, acknowledging they have not yet applied and committing to obtain certificates before contract execution, or claiming exemption if they have not employed 40 or more employees on a single day during the prior 12 months in Minnesota or their primary state of business. The form requires completion of Part 2 business information including Vendor/Supplier ID, business name, contracting agency name, authorized signatory information, and contact details. Unit prices must include all costs such as labor, materials, tools, transportation, equipment, and applicable taxes. The State reserves the right to award items separately, by grouping, or by total as deemed most advantageous, and will make the award to the lowest responsible vendor meeting all specifications and terms and conditions. The price schedule is provided in Excel format and must be downloaded, completed, and uploaded with the bid response.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachments_and_Declarations.docx | DOCX document | |
| 2026-908_EVENT_Specifications.pdf | ||
| RFP_Rubbish_Disposal_MNDOT_Dist_7.pdf | ||
| DNR_RFB_Rice_County_Observation_Well_Drilling.pdf | ||
| 2026-908_Solicitation_Bond_Forms.pdf | ||
| R-712_Sample_Contract_and_Exhibits.pdf | ||
| Exhibit_D_Price_Schedule_MNDOT_Dist_7.xlsx | XLSX spreadsheet | |
| 2026-908_Price_Schedule.xlsx | XLSX spreadsheet | |
| 2026-908_Attachment_A_-_First_Tier_Subcontractors_List.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 .