Workforce_and_Declaration_Response_Form.pdf
PDF 233 KB Posted
- Attached to
- DNR RFB Big Stone Tract 10 Wetland Restorations
- Solicitation number
- 2000018095
- Issued by
- Big Stone 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 or Metropolitan agencies, the University of Minnesota for general obligation bond-funded capital projects, or Political Subdivisions for general obligation bond-funded capital projects. The form applies to contracts exceeding $100,000 for Workforce Certificates and $500,000 for Equal Pay Certificates with State or Metropolitan agencies; exceeding $100,000 for Workforce Certificates and $500,000 for Equal Pay Certificates with the University of Minnesota for bond-funded capital projects; and exceeding $250,000 for Workforce Certificates and $1,000,000 for Equal Pay Certificates with Political Subdivisions for bond-funded capital projects. Contractors must declare their certification status, including whether they hold current certificates, have applications pending, have not applied, or qualify for exemption based on employee count.
The form requires contractors to indicate their certification status in Part 1 by selecting whether they are current certificate holders, have applied or are applying for certificates with specified application dates, have not yet applied and acknowledge the requirement to obtain certificates before contract execution, or are exempt based on not employing 40 or more employees on a single day during the prior 12 months in Minnesota or their primary state of business. Part 2 requires submission of business information including vendor/supplier identification, business name, contracting agency name, authorized signatory details, and contact information. Contractors without required certificates or approved exemptions cannot execute contracts, and the Minnesota Department of Human Rights may verify employment records and employee counts upon request.
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Other files
| File | Type | Posted |
|---|---|---|
| 2026-763_Price_Schedule.xlsx | XLSX spreadsheet | |
| DNR_RFB_Big_Stone_Tract_10_Wetland_Restorations.pdf | ||
| 2026-763_Solicitation.pdf | ||
| 2026-763_Contractor_Qualification_Form.pdf | ||
| 2026-763_First-Tier_Subcontractor_List.pdf | ||
| 2026-763_Solicitation_Bond_Forms.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
X 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 .