Workforce_and_Equal_Pay_Declaration_Page.pdf
PDF 154 KB Posted
- Attached to
- DNR RFB NW Region Site Prep & Release 2025
- Solicitation number
- 2000016807
- Issued by
- Big Stone County, Minnesota
About this file
The Workforce and Equal Pay Declaration Page is a form required by the Minnesota Department of Human Rights for businesses executing government contracts with State, Metropolitan agencies, University of Minnesota, or Political Subdivisions. The form applies to contracts exceeding specific monetary thresholds: $100,000 for State/Metropolitan agencies and University of Minnesota projects, and $250,000 for Political Subdivision projects. Businesses must obtain or demonstrate eligibility for Workforce and Equal Pay Certificates before contract execution, with specific requirements for businesses employing 40 or more employees.
The document provides a framework for businesses to declare their certificate status, including options to indicate current certificate holders, applicants for certificates, or businesses seeking exemption. Exemptions are available for companies that have not employed 40 or more employees on a single day during the previous 12 months in Minnesota or their primary place of business. The form requires businesses to provide basic contact and identification information, and includes a provision for the Minnesota Department of Human Rights to review and verify exemption claims. Businesses must submit this declaration as part of the contract compliance process, with assistance available through the department's compliance email.
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| 2025-641_PRICE_SCHEDULE.xlsx | XLSX spreadsheet | |
| 2025-641_Addendum_1.pdf | ||
| 2025-641_Qualification_Form.pdf | ||
| 2025-641_Equipment_Form.pdf | ||
| 2025-641_Specifications___Terms_Addendum_1.pdf | ||
| 2025-641_Price_Sched_Addendum_1.xlsx | XLSX spreadsheet | |
| 2025-641_Specifications.pdf | ||
| DNR_RFB_NW_Region_Site_Prep___Release_2025.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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