Attachment D: Workforce and Equal Pay Declaration Page

This is a compliance form required by the Minnesota Department of Human Rights (MDHR) for businesses executing government contracts with State or Metropolitan agencies, the University of Minnesota for general obligation bond-funded capital projects, or Political Subdivisions for general obligation bond-funded capital projects. The form applies to contracts exceeding $100,000 for Workforce Certificates and $500,000 for Equal Pay Certificates with State or Metropolitan agencies; $100,000 and $500,000 respectively with the University of Minnesota; and $250,000 and $1,000,000 respectively with Political Subdivisions. Vendors must declare their certification status by selecting one of four categories: current certificate holders, applicants for certificates, businesses without certificates that acknowledge the requirement before contract execution, or businesses claiming exemption based on employee count thresholds.

The form requires vendors to provide business information including vendor/supplier ID, business name, contracting agency name, authorized signatory details, and contact information. Businesses claiming exemption must attest that 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, with the understanding that MDHR may request verification documentation including employee names, separation dates, and current employment status. All submissions must be signed and dated by an authorized company representative and directed to the Minnesota Department of Human Rights Compliance office for processing and approval prior to contract execution.