LIVING_WAGE_CERTIFICATION.pdf

PDF 227 KB Posted

Attached to
EAST SIDE PLAZA SIGNAGE
Solicitation number
25/26-20
Issued by
Hartford County, Connecticut

About this file

This document is a Living Wage Certification Form from the Town of Manchester, Massachusetts, relating to a municipal contract subject to the Manchester Living Wage Ordinance (Chapter 212, Sections 212-1 through 212-11). The form requires bidders to declare whether they are a "Covered Employer" under the ordinance, which mandates paying a living wage to eligible employees during the contract term. Bidders must complete and return this form with their Bid/RFP submission, with failure to do so potentially resulting in bid rejection.

The form provides three potential exemption categories for employers: those with fewer than 25 eligible employees, contracts with an annual value less than $25,000, and certain charitable foundations, trusts, or nonprofit organizations exempt from federal income taxation under Section 501 of the Internal Revenue Code. The document requires the authorized representative of the bidding company to certify the accuracy of their declaration by signing and dating the form, indicating compliance with or exemption from the living wage requirements for the specific bid or proposal.

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Text version

TOWN OF MANCHESTER

LIVING WAGE CERTIFICATION FORM

The Town of Manchester has determined that this contract may be subject to the provisions of the

Manchester Living Wage Ordinance, Chapter 212 of the Manchester Code of Ordinances, Sections 212-1 through 212-11.

Bidders are required to indicate whether they are a Covered Employer as defined by the Manchester

Living Wage Ordinance or are exempt from the requirements by marking the appropriate section below.

*****Failure to complete and return this form may result in the rejection of your Bid/RFP.*****

I/We are a covered employer and shall pay the required living wage to eligible employees and comply with the requirements of the ordinance during the term of the contract.

OR

I/We are not a Covered Employer and therefore not subject to Manchester’s Living Wage

Ordinance for the reason(s) indicated below.

Please indicate the reason, if you are not a covered employer, by checking the box or boxes that apply directly below.

Bidder employs less than twenty-five (25) eligible employees.

Annual contract value is less than $25,000.

Charitable foundations, charitable trusts or nonprofit agencies or nonprofit corporations, provided that the foundation, trust or nonprofit agency or corporation is exempt from federal income taxation and may accept charitable contributions under Section 501 of the Internal Revenue Code of 1986, or any subsequent corresponding internal revenue code of the United States, as from time to time amended.

I, __________________________________________ am the Officer, Owner, Authorized Representative of ______________________________________________________________, the company named in the Bid or RFP, and do hereby certify that the representations made above are true and correct for

Bid/RFP Number________________ Bid/RFP Name ___________________________________________

Signature Print Name

Date

Please return with your Bid or RFP submission.

C h e ck a ny t h at a pp ly

S ig n

D at e h e ck

O nl y O ne om pl e te t h is

S e ct io n

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