FORM_-_Workforce_and_Declaration_Response.pdf
PDF 178 KB Posted
- Solicitation number
- 2000018640
- Issued by
- Minnesota
About this file
This is a Workforce and Equal Pay Declaration Response Form required by the Minnesota Department of Human Rights for contractors executing government contracts in Minnesota. The form applies to businesses contracting with State or Metropolitan agencies for projects exceeding $100,000 (Workforce Certificate requirement) and $500,000 (Equal Pay Certificate requirement), as well as contracts with the University of Minnesota for general obligation bond-funded capital projects exceeding the same thresholds, and contracts with Political Subdivisions for general obligation bond-funded capital projects exceeding $250,000 and $1,000,000 respectively. Contractors must complete Part 1 by selecting one of four options: confirming they hold current Workforce and/or Equal Pay Certificates, indicating they have applied for such certificates with application dates, stating they have not yet applied and acknowledging the requirement to obtain certification before contract execution, or claiming exemption based on employing fewer than 40 employees during the prior 12 months in Minnesota or their primary state of business.
Part 2 of the form requires submission of standard business information including the vendor/supplier ID, business name, contracting agency name, authorized signatory details, date, signature, email, and phone number. For the related DNR contract opportunity (2027-243 Reno Bluffs Basal Bark Invasives Treatment), this declaration form must be completed as the contract value will likely exceed the $100,000 threshold. Contractors requiring assistance with form completion or registration should contact the Contractor Assistance Help Desk at 651-201-8100, Option 1, or email the Minnesota Department of Human Rights Compliance at Compliance.MDHR@state.mn.us. All responses must be submitted electronically through the Swift Portal, and failure to submit the required documentation may result in bid rejection.
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Other files
| File | Type | Posted |
|---|---|---|
| DNR_RFB_Reno_Bluffs_Basal_Bark_Invasives_Treatment.pdf | ||
| 2027-243_Specifications.pdf | ||
| 2027-243_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
File details come from the government source that posted it. Updated .