LIVING_WAGE_CERTIFICATION.pdf

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Attached to
CONCRETE REPAIRS AT HOCKANUM RIVER WATER POLLUTION CONTROL FACILITY
Solicitation number
25/26-41
Issued by
Hartford County, Connecticut

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This is a Living Wage Certification Form required by the Town of Manchester, Connecticut for the Concrete Repairs at Hockanum River Water Pollution Control Facility project. The Town of Manchester has determined that this contract may be subject to the Manchester Living Wage Ordinance, Chapter 212 of the Manchester Code of Ordinances, Sections 212-1 through 212-11. Bidders are required to complete and return this certification form as part of their bid or RFP submission, with failure to do so potentially resulting in bid rejection. The form requires bidders to indicate their status as either a covered employer subject to living wage requirements or an exempt entity.

Bidders may claim exemption from the living wage ordinance requirements based on three qualifying criteria: employing fewer than twenty-five eligible employees, an annual contract value below $25,000, or operating as a charitable foundation, charitable trust, or nonprofit organization exempt from federal income taxation under Section 501 of the Internal Revenue Code. Covered employers must certify their commitment to paying the required living wage to eligible employees and complying with all ordinance requirements throughout the contract term. An authorized officer, owner, or representative must sign and date the certification, providing the bidder's company name, bid or RFP number, and bid or RFP name.

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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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