OF MINNESOTA EQUAL PAY CERTIFICATE – If your proposal could be in excess of $500,000, complete and submit this form with your submission. It is your sole responsibility to provide the information requested and, when necessary, to obtain an Equal Pay Certificate from the Minnesota Department of Human Rights (MDHR) prior to contract execution. You must supply this document as part of your proposal. Contact MDHR with questions at 651-539-1095 (metro), 1-800-657-3704 (toll free), 711 or 1-800-627-3529 (MN Relay), or at . Option A If you have employed more than 40 full-time employees on any single working day in one state during – the previous 12 months, check the applicable box below: Attached is our current MDHR Pay Certificate Attached is MDHR’s confirmation of our Equal Pay Certificate application Option B If you have not employed more than 40 full-time employees on any single working day in one – state during the previous 12 months, check the box below: We are exempt. We agree that if we are selected, we will submit to MDHR within five business days of final contract execution, the names of our employees during the previous 12 months, date of separation (if applicable), and the state in which the persons were employed. Documentation should be sent to: The State of Minnesota reserves the right to request additional information from you. If you are unable to check any of the preceding boxes, please contact MDHR to avoid the Commissioner taking action to void your contract. Your signature certifies that you are authorized to make the representations, the information provided is accurate, the State of Minnesota can rely upon the information provided, and the State of Minnesota may take action to suspend or revoke any contract with you for any false information provided. Authorized Signature Printed Name Title Organization MN/FED Tax ID# Date Issuing Entity Project # or Lease Address
OF MINNESOTA – EQUAL PAY CERTIFICATE If your proposal could be in excess of $500,000, complete and submit this form with your submission. It is your sole responsibility to provide the information requested and, when necessary, to obtain an Equal Pay Certificate from the Minnesota Department of Human Rights (MDHR) prior to contract execution. You must supply this document as part of your proposal. Contact MDHR with questions at 651-539-1095 (metro), 1-800-657-3704 (toll free), 711 or 1-800-627-3529 (MN Relay), or at . Option A – If you have employed more than 40 full-time employees on any single working day in one state during the previous 12 months, check the applicable box below: Attached is our current MDHR Pay Certificate Attached is MDHR’s confirmation of our Equal Pay Certificate application Option B – If you have not employed more than 40 full-time employees on any single working day in one state during the previous 12 months, check the box below: We are exempt. We agree that if we are selected, we will submit to MDHR within five business days of final contract execution, the names of our employees during the previous 12 months, date of separation (if applicable), and the state in which the persons were employed. Documentation should be sent to: The State of Minnesota reserves the right to request additional information from you. If you are unable to check any of the preceding boxes, please contact MDHR to avoid the Commissioner taking action to void your contract. Your signature certifies that you are authorized to make the representations, the information provided is accurate, the State of Minnesota can rely upon the information provided, and the State of Minnesota may take action to suspend or revoke any contract with you for any false information provided. Authorized Signature Printed Name Title Organization MN/FED Tax ID# Date Issuing Entity Project # or Lease Address
cmgc-rfp-nov-3-2017.docx