Workforce_and_Declaration_Response_Form.pdf
PDF 151 KB Posted
- Attached to
- DNR RFB PWA Portable Toilet Services 2026-2027
- Solicitation number
- 2000017869
- Issued by
- Aitkin County, Minnesota
About this file
This is a Workforce and Equal Pay Declaration Response Form required by the Minnesota Department of Human Rights for businesses executing government contracts with state and local agencies. The form applies to the Department of Natural Resources (DNR) Request for Bids (RFB) for Brainerd Area Portable Toilet Services 2026-2027, which seeks bids for labor, equipment, materials, tools, transportation, and incidentals necessary to provide and service portable toilets at various public access sites in Aitkin, Crow Wing, and Mille Lacs Counties in East Central Minnesota. Prospective contractors must submit responses electronically through the Swift Portal, with a site visit available by contacting Keri Hull, Site Contact and Project Supervisor, at 218-280-8265 or Keri.Hull@state.mn.us. The Contractor Assistance Help Desk is available at 651-201-8100, Option 1, for registration and response completion assistance. All responses must comply with the solicitation requirements, and the award will be made to the lowest responsible vendor meeting specifications and all terms and conditions.
Contractors must complete the Workforce and Equal Pay Declaration Response Form by selecting one of four options: holding a current Workforce Certificate and/or Equal Pay Certificate; applying for these certificates; acknowledging they have not applied and will obtain certification before contract execution; or claiming exemption by attesting 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. The certificate requirements apply to state and metropolitan agency contracts exceeding $100,000 (Workforce Certificate) and $500,000 (Equal Pay Certificate), University of Minnesota general obligation bond funded capital projects exceeding $100,000 and $500,000 respectively, and political subdivisions' general obligation bond funded capital projects exceeding $250,000 and $1,000,000 respectively. Unit pricing must include all costs such as labor, materials, tools, transportation, equipment, sales tax, and use tax. A Price Schedule in Excel format is attached and must be downloaded, completed, and uploaded by contractors submitting bids.
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Other files
| File | Type | Posted |
|---|---|---|
| 2026-540_Price_Schedule.xlsx | XLSX spreadsheet | |
| 2026-540_Specifications.pdf | ||
| DNR_RFB_PWA_Portable_Toilet_Services_2026-2027.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
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