2027_030_Workforce_and_Declaration_Response.pdf
PDF 178 KB Posted
- Solicitation number
- 2000018507
- Issued by
- Aitkin 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. The form applies to three categories of contracting entities: businesses executing contracts with State or Metropolitan agencies exceeding $100,000 (Workforce Certificate) and $500,000 (Equal Pay Certificate); businesses executing contracts with the University of Minnesota for general obligation bond-funded capital projects exceeding $100,000 (Workforce Certificate) and $500,000 (Equal Pay Certificate); and businesses executing contracts with Political Subdivisions for general obligation bond-funded capital projects exceeding $250,000 (Workforce Certificate) and $1,000,000 (Equal Pay Certificate).
The form requires contractors to declare their certification status across four options: confirmation of current certificate holder status under specified names; application status with specific application dates; acknowledgment that certificates have not been applied for and recognition that certificates or approved exemption are required before contract execution; or attestation of exemption based on employment of fewer than 40 employees on a single day during the prior 12 months in Minnesota or the contractor's primary state of business. Contractors must complete business information sections including vendor/supplier identification, business name, contracting agency name, authorized signatory details, and contact information. The Minnesota Department of Human Rights reserves the right to request employee records, including names, separation dates, and employment status verification. Assistance with form completion is available through the Department of Human Rights Compliance office.
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| 2027_030_Specifications_and_Terms.pdf | ||
| DNR_RFB_2027-030_NE_Region_2_Bud_Capping_and_Pruni.pdf | ||
| 2027_030_Qualification_Form.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
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