Workforce and Equal Pay Declaration Page_tcm1061-519001 (7).pdf
PDF 154 KB Posted
- Solicitation number
- SRC-SMSU-2026-000509-RFP
- Issued by
- Minnesota
About this file
This is a Workforce and Equal Pay Declaration Form issued by the Minnesota Department of Human Rights for businesses executing government contracts with state, metropolitan, university, and political subdivision agencies. The form applies to contracts exceeding specified dollar thresholds: $100,000 for Workforce Certificates and $500,000 for Equal Pay Certificates with State or Metropolitan agencies; $100,000 and $500,000 respectively for University of Minnesota general obligation bond-funded capital projects; and $250,000 and $1,000,000 respectively for Political Subdivisions' general obligation bond-funded capital projects. Bidders must declare their certification status by selecting from multiple options: holding current Workforce and/or Equal Pay Certificates, having applied for such certificates with application dates, having not yet applied, or qualifying for exemption based on having fewer than 40 employees during the prior 12 months in Minnesota or their primary state of business.
The form requires vendors to provide business information including vendor/supplier identification, business name, contracting agency name, authorized signatory details, and contact information. Vendors claiming exemption status must attest that they have not employed 40 or more employees on a single day during the previous 12 months and may provide additional justification for their exemption claim. The Minnesota Department of Human Rights reserves the right to verify employment claims by requesting employee rosters, separation dates, and current employment status. All Workforce and Equal Pay Certificates or approved exemptions must be obtained before contract execution. Assistance with the form is available through the Minnesota Department of Human Rights Compliance at MDHR@state.mn.us, with additional resources available at mn.gov/mdhr/certificates/.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 1358864-event.pdf | ||
| 6b_services (2)Volleyball-draft-contract.docx | DOCX document | |
| co.21 prevailing wage faq 02 13 2020-0021 (2).pdf | ||
| 2025 Expense Reimbursement.pdf | ||
| GeoBlue brochure 2025_2026.pdf | ||
| foreigncorpregistration.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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?: |
File details come from the government source that posted it. Updated .