LIVING_WAGE_CERTIFICATION.pdf

PDF 227 KB Posted

Attached to
FALL PROTECTION FOR HRWPCF
Solicitation number
25/26-15
Issued by
Hartford County, Connecticut

About this file

This document is a Living Wage Certification Form from the Town of Manchester, specifically related to the Manchester Living Wage Ordinance (Chapter 212, Sections 212-1 through 212-11). The form requires bidders to certify whether they are a "Covered Employer" subject to the living wage requirements or are exempt from these provisions. Bidders must complete and return this form with their Bid/RFP submission, with a warning that failure to do so may result in bid rejection.

The form provides three potential exemption criteria: employing fewer than 25 eligible employees, having an annual contract value less than $25,000, or being a charitable foundation/nonprofit with federal tax-exempt status under Section 501 of the Internal Revenue Code. The certification requires the bidder's authorized representative to sign and affirm the truthfulness of their classification, either as a covered employer committed to paying the required living wage or as an exempt entity. The form is designed to ensure compliance with the municipal living wage regulations and must be submitted as part of the bidding process.

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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

File details come from the government source that posted it. Updated .