Workforce_and_Equal_Pay_Declaration_Page.pdf
PDF 154 KB Posted
- Attached to
- DNR RFB NE Region Brushsaw Release & TSI
- Solicitation number
- 2000016972
- Issued by
- Aitkin County, Minnesota
About this file
This document is a Workforce and Equal Pay Declaration Page issued by the Minnesota Department of Human Rights, applicable to businesses executing government contracts with State or Metropolitan agencies, the University of Minnesota, and Political Subdivisions. The form is required for contracts exceeding specific monetary thresholds: $100,000 for Workforce Certificates and $500,000-$1,000,000 for Equal Pay Certificates, depending on the contracting entity and project type.
The declaration form allows businesses to indicate their current certification status, application status, or exemption from these workforce and equal pay requirements. Businesses must either hold a Workforce or Equal Pay Certificate, be in the process of applying for one, or qualify for an exemption (such as employing fewer than 40 employees in the past 12 months). The form requires detailed business information and serves as a compliance document to ensure equal employment practices before contract execution, with the Minnesota Department of Human Rights retaining the authority to review and validate the submitted information.
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Other files
| File | Type | Posted |
|---|---|---|
| DNR_RFB_NE_Region_Brushsaw_Release___TSI.pdf | ||
| 2025-674_PRICE_SCHEDULE.xlsx | XLSX spreadsheet | |
| 2025-674_Specifications___Terms.pdf |
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Text version
Workforce and Equal Pay Declarations Page Rev. 6/1/2023
Workforce and Equal Pay Declaration Page
This form is required for all businesses executing government contracts under the following:
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 Certificate)
Select all that apply:
We are a certificate holder:
☐ Workforce Certificate under the name: _________________________________________________________ ☐ Equal Pay Certificate under the name: __________________________________________________________
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): ____________________
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.
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 which 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.
☐ We believe our company is exempt because ___________________________________________________.
The Minnesota Department of Human Rights will review and determine if your company is exempt.
Business Information
Vendor/Supplier ID Vendor Email
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 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/workforce-certificate/ https://mn.gov/mdhr/certificates/equalpay/
| Workforce and Equal Pay Declaration Page |
| Select one: |
| Select all that apply: |
| We are a certificate holder: |
| We are applying/have applied for the following certificate(s): |
| We have not applied for one or both certificates: |
| We are Exempt: |
Business Information
| State or Metropolitan agencies: Off |
| University of Minnesota: Off |
| Political Subdivisions: Off |
| Vendor/Supplier ID: |
| Vendor Email: |
| Name of Contracting Agency: |
| Business Name: |
| Authorized Signatory Name: |
| Title: |
| Date: |
| Email: |
| Phone: |
| We are a Workforce Certificate holder: Off |
| We are a Equal Pay Certificate holder: Off |
| We are applying/have applied for a Workforce Certificate: Off |
| We are applying/have applied for a Equal Pay Certificate: Off |
| What is the application date of your Workforce Certificate?: |
| What is the application date of your Equal Pay Certificate?: |
| We have not applied for one or both certificates: Off |
| 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: Off |
| We believe our company is exempt: Off |
| Why do you believe your company is exempt?: |
| What name is your Workforce Certificate under?: |
| What name is your Equal Pay Certificate under?: |
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