Workforce_and_Declaration_Form.pdf
PDF 178 KB Posted
- Attached to
- DNR RFB NW Region Bud Capping 2026
- Solicitation number
- 2000018470
- Issued by
- Beltrami County, Minnesota
About this file
This is a Prime Contractor Response Form for Workforce and Equal Pay Declaration requirements established by the Minnesota Department of Human Rights for businesses executing government contracts with state, local, and university entities. The form applies to contractors entering into agreements exceeding specified thresholds: $100,000 for Workforce Certificates with State or Metropolitan agencies, $100,000 for University of Minnesota general obligation bond-funded capital projects, and $250,000 for Political Subdivisions' general obligation bond-funded capital projects. Contractors must declare their certification status by selecting one of four options: current certificate holder status, pending application status with submission dates, non-application status with acknowledgment that certification is required before contract execution, or exemption status based on employment levels.
The form requires contractors to provide business information including vendor/supplier identification, business name, contracting agency name, authorized signatory details, and contact information. Businesses claiming exemption must attest they have not employed 40 or more employees on a single day during the prior 12 months in Minnesota or their primary state of business. Equal Pay Certificates are additionally required for contracts exceeding $500,000 with State or Metropolitan agencies and $1,000,000 with Political Subdivisions for general obligation bond-funded capital projects. The Minnesota Department of Human Rights reserves the right to request documentation including employee names, separation dates, and current employment status to verify exemption claims. Technical assistance is available through the Minnesota Department of Human Rights Compliance office.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 2027-055_Qualification_Form.pdf | ||
| 2027-055_Specifications.pdf | ||
| DNR_RFB_NW_Region_Bud_Capping_2026.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .