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<br />Attachment to the Proposal Instructions: <br />4. Affirmative Action Certification Statement <br /> <br />(See Proposal Instructions, Section 17, for more information.) <br /> <br />Proposer Company Name: <br /> <br />Contract # Project Name: Ramsey Star Express Transit Service <br /> <br />(NOTE: If the proposal amount exceeds $100,000, EITHER this form OR a currently effective affirmative action <br />Certificate of Compliance for the Proposer, issued by the Minnesota Department of Human Rights, MUST be <br />submitted with the proposal. See section 17 of the Instructions to Proposers for additional information.) <br /> <br />Instructions: If a proposal is in an amount greater than $100,000, the City cannot accept the proposal unless the Proposer <br />can affirm either Statement #1 or Statement #2 below. The Proposer must select (by checking the appropriate box) and <br />certify as true one of the two statements below, if it is able to do so. In making its certification, the Proposer should carefully <br />bear in mind the post-submittal requirements noted in connection with each statement. After submittal of the proposal the <br />Council reserves the right to require documentation from the Proposer supporting the certification or to otherwise verify the <br />accuracy of the certification. If neither statement can be affirmed, no proposal should be submitted. <br /> <br />~1. <br /> <br />CHECK ONLY ONE BOX! <br /> <br />~2. <br /> <br />The business executing this certification did have more than 40 full-time employees within the State <br />of Minnesota on one or more working days during the 12 months previous to the date the proposal is <br />due. IN ADDITION, the business either: <br />a, has submitted an affirmative action plan for the employment of minority persons, women, and <br />qualified disabled individuals to the Commissioner of Human Rights for approval; or <br />b. has a currently effective Certificate of Compliance from the Commissioner of Human Rights <br />indicating that it has an approved affirmative action plan. <br /> <br />Note: Prior to execution of any agreement arising out of this procurement, the Proposer will <br />be required to provide the Council with a copy of its currently effective Certificate of <br />Compliance. <br /> <br />The business executing this certification did not have more than 40 full-time employees within the State <br />of Minnesota on any working day during the 12 months previous to the date the proposal is due. <br /> <br />Note: Prior to execution of any agreement arising out of this procurement, the Proposer will be <br />required to provide the Council with at least one of the following on a form to be provided by the <br />Council: <br />a. a certification that the business has a currently effective Certificate of Compliance issued by the <br />Commissioner of Human Rights, along with the copy of that document; or <br />b. a certification that the business is in compliance with federal affirmative action requirements; or <br />c. a certification that the business's primary place of business is not in the United States; or <br />d. a certification that the business did not have more than 40 full-time employees on any working day <br />during the 12 months prior to the date on which it submitted its proposal, in the state where the <br />business has its primary place of business. <br /> <br />CERTIFICATION <br />On behalf of the Proposer, I certify that the above response is true as of the date this form is signed. I have <br />read and understand the requirements related to this certification statement. <br /> <br />Proposer Name: <br /> <br />By: <br />Name: <br /> <br />Date: <br />Title: <br /> <br />Attachment to the Proposal Instructions: Affirmative Action Certification Statement <br />Page 4-1 <br />