FORM_-_Workforce_and_Declaration_Response.pdf
PDF 178 KB Posted
- Attached to
- DNR RFB Mound Prairie SNA Woody Removal
- Solicitation number
- 2000018684
- Issued by
- Minnesota
About this file
Summary of Workforce and Declaration Response Form
This is a Prime Contractor Response Form issued by the Minnesota Department of Human Rights (MDHR) requiring workforce and equal pay certification declarations for businesses executing government contracts in Minnesota. The form applies to contracts with State or Metropolitan agencies exceeding $100,000 (Workforce Certificate) and $500,000 (Equal Pay Certificate), University of Minnesota general obligation bond-funded capital projects exceeding $100,000 (Workforce) and $500,000 (Equal Pay), and Political Subdivisions' general obligation bond-funded capital projects exceeding $250,000 (Workforce) and $1,000,000 (Equal Pay). Contractors must declare their certification status by selecting one of four options: holding active certificates, applying or having applied for certificates, not having applied for certificates, or claiming exemption based on not employing 40 or more employees during the prior 12 months in Minnesota or their primary state of business.
Contractors must complete Part 2 of the form by providing business information including Vendor/Supplier ID, business name, contracting agency name, authorized signatory details, and contact information. All contractors without existing certificates must acknowledge that a Workforce Certificate and, if applicable, an Equal Pay Certificate or approved exemption from MDHR is required before contract execution. Exemption claims may be verified by MDHR through employee records requests. Completed forms should be submitted to the Minnesota Department of Human Rights Compliance office at Compliance.MDHR@state.mn.us for processing and verification before contract award.
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Other files
| File | Type | Posted |
|---|---|---|
| overview.pdf | ||
| tasks_2_3.pdf | ||
| elevation.pdf | ||
| burn_piles.pdf | ||
| DNR_RFB_Mound_Prairie_SNA_Woody_Removal.pdf | ||
| tasks_1_4.pdf | ||
| 2026-262_Prime_Response_Qualification_Form.pdf | ||
| 2027-262_ADDENDUM_1.pdf | ||
| 2027-262_Specifications.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 .