Attachment_D.pdf
PDF 154 KB Posted
- Attached to
- MNIT/DOC MINNCOR eCommerce Solution
- Solicitation number
- 2000018420
- Issued by
- Ramsey 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, metropolitan, and local agencies. The form applies to contracts exceeding $100,000 with State or Metropolitan agencies, $100,000 with University of Minnesota for general obligation bond funded capital projects, and $250,000 with Political Subdivisions for general obligation bond funded capital projects. Bidders must declare their status regarding Workforce and Equal Pay Certificates, which are mandatory before contract execution unless the company qualifies for an exemption based on employee count during the prior 12 months.
Companies must select their certificate status by indicating whether they are current certificate holders, have applied for certificates with specific application dates, have not applied, or are claiming exemption based on not employing 40 or more employees on a single day in Minnesota or their primary state of business during the previous 12 months. The form requires submission of business information including vendor/supplier ID, business name, contracting agency name, and authorized signatory details. Companies claiming exemption status must attest to their employee count, and the Minnesota Department of Human Rights reserves the right to request documentation of employee names, separation dates, and current employment status to verify exemption eligibility. For the MNIT/DOC MINNCOR eCommerce Solution contract, all responding vendors must complete this declaration form as part of their bid submission.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment_C_-_Cost_Detail.docx | DOCX document | |
| Attachment_F_-_MINNCOR_s_Product_Lines.docx | DOCX document | |
| ptsamplecontractsandexhibits.docx | DOCX document | |
| Attachment_A_and_B.pdf | ||
| RFP_Addendum__2.docx | DOCX document | |
| MNIT_DOC_MINNCOR_eCommerce_Solution.pdf | ||
| RFP_Template_MINNCOR_eCommerce_Solution_2026_Final_V2.docx | DOCX document | |
| Attachment_E_-_Solution_Requirements_V3.docx | DOCX document | |
| RFP_Addendum__1.docx | DOCX document | |
| RFP_Addendum__3.docx | DOCX document |
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Text version
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: Off |
| 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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