Workforce_and_Declaration_Response_Form.pdf
PDF 178 KB Posted
- Solicitation number
- 2000018251
- Issued by
- St. Louis County, Minnesota
About this file
Workforce and Declaration Response Form for Minnesota State and Local Contracts
This is a Prime Contractor Response Form required by the Minnesota Department of Human Rights for businesses executing government contracts with state, local, and university entities. The form applies to the Department of Natural Resources' Request for Bids (RFB 2026-897) for Greywacke Bedrock Observation Well drilling in Southern St. Louis County. The project involves installing up to two groundwater environmental wells using air-driven/air hammer drilling methods. Contractors must be registered and licensed with the Minnesota Department of Health as a Well Contractor. Site visits are available by contacting Project Supervisor Jacob Kolke at 651-392-9491. All responses must be submitted electronically through the Swift Portal with no email or faxed submissions accepted. The Contractor Assistance Help Desk is available at 651-201-8100, Option 1, for registration and response completion assistance.
Contractors must declare their status regarding Workforce and Equal Pay Certificates from the Minnesota Department of Human Rights. The thresholds for certification requirements vary by contracting entity: State or Metropolitan agencies require certification for contracts exceeding $100,000 (Workforce) and $500,000 (Equal Pay); University of Minnesota general obligation bond-funded capital projects require certification for contracts exceeding $100,000 (Workforce) and $500,000 (Equal Pay); and Political Subdivisions require certification for contracts exceeding $250,000 (Workforce) and $1,000,000 (Equal Pay). Contractors with fewer than 40 employees on a single day during the prior 12 months in Minnesota or their primary state of business may claim exemption. Unit pricing must include all labor, materials, tools, transportation, equipment, sales tax, use tax, and all costs necessary for project completion. Award will be made to the lowest responsible vendor meeting specifications and all terms and conditions, with the State reserving the right to award items separately, by grouping, or by total as deemed most advantageous.
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Other files
| File | Type | Posted |
|---|---|---|
| 2026-897_Specifications___Terms.pdf | ||
| 2026-897_SOLICITATION_BOND.pdf | ||
| 2026-897_Attachment_A___A1_forms.pdf | ||
| 2026-897_Prime_Response_Form.pdf | ||
| DNR_RFB_St_Louis_Co_Greywacke_Bedrock_Obwell_Drill.pdf | ||
| 2026-897_Price_Schedule.xlsx | XLSX spreadsheet |
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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 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
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