2027_001_Workforce_and_Declaration_Response.pdf
PDF 178 KB Posted
- Solicitation number
- 2000018349
- Issued by
- Lyon County, Minnesota
About this file
This is a Prime Contractor Response Form for Workforce and Equal Pay Declaration 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. The form applies to the DNR RFB for Thief River Falls Area Buckthorn Treatment, which seeks labor, equipment, materials, tools, transportation, and incidentals necessary to cut and/or chemically treat invasive buckthorn on approximately 158.9 acres across Valley WMA in Marshall County and Higginbotham WMA in Pennington County. The project consists of two years of treatment, with Year One serving as initial treatment and Year Two as follow-up treatment for re-sprouts and missed or surviving mature plants. Responses must be submitted electronically through the Swift Portal, and contractors requiring assistance may contact the Contractor Assistance Help Desk at 651-201-8100, Option 1. Potential bidders can schedule site visits by contacting Project Supervisor Rebecca Ekstein at 218-219-8588. All vendors are responsible for reviewing attachments and complying with all requirements, with DNR serving as the determining factor for specification compliance.
Contractors must declare their status regarding Workforce and Equal Pay Certificates, which are required before contract execution unless an exemption applies. Certificate requirements vary by contract recipient and value: contracts with State or Metropolitan agencies exceed $100,000 for Workforce Certificates and $500,000 for Equal Pay Certificates; University of Minnesota general obligation bond-funded capital projects exceed $100,000 for Workforce and $500,000 for Equal Pay; and Political Subdivision general obligation bond-funded capital projects exceed $250,000 for Workforce and $1,000,000 for Equal Pay. Businesses with fewer than 40 employees on a single day during the prior 12 months in Minnesota or their primary state of business may claim an exemption. Unit pricing must include all costs such as labor, materials, tools, transportation, equipment, and applicable taxes. The award will be made to the lowest responsible vendor meeting specifications and all terms and conditions, with the State reserving the right to award items separately, by grouping, or by total.
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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
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