Laboratory Assessment of Pre-Wetting Application Rates -REPOSTED

State of Minnesota
REQUEST FOR PROPOSAL (RFP)
PART B: FORMS AND DECLARATIONS
Laboratory Assessment of Pre-Wetting Application Rates
MnDOT Contract Number: 1060859
Date Posted: 07/14/2026
1. Responder is required to complete and submit the following Forms and Declarations with its Proposal no later
than the date and time published in PART A of the RFP.
2. This document is available in alternative formats for persons with disabilities by calling Michael Friberg at 651-
366-4683 or for persons who are hearing, or speech impaired by calling the Minnesota Relay Service at 1-800-
627-3529. For other information on disability rights and protections, contact MnDOT's Americans with
Disabilities Act (ADA) Coordinator.
3. These Forms and Declarations will NOT be included in the Proposal's page limits set for this RFP, as applicable,
which is provided in Section 3, PART A of this RFP.
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ATTACHMENT 1: RESPONDER DECLARATIONS & CERTIFICATIONS
The undersigned declares and certifies, to the best of their knowledge and belief, that:
1. Proposal Contents.
The information provided is true, correct, and reliable for purposes of evaluation for potential contract award. The
submission of inaccurate or misleading information may be grounds for disqualification from the award as well as
subject the Responder to suspension or debarment proceedings as well as other remedies available to MnDOT by
law.
2. Authorized Signature.
The Proposal, as well as all attachments and other required documents, including without limitation these
Declarations and Certifications, are signed by the appropriate person(s), with the authority to contractually bind the
Responder, as required by applicable articles, bylaws, resolutions, minutes, and ordinances.
3. Non-Collusion Certification.
The Proposal has been arrived at by the Responder independently and has been submitted without collusion and
without any agreement, understanding or planned common course of action with any other Responder designed to
limit fair or open competition; and
The contents of the Proposal have not been communicated by the Responder or its employees or agents to any
person not an employee or agent of the Responder and will not be communicated to any other individual prior to
the due date and time of this RFP. Any evidence of collusion among Responders in any form designed to defeat
competitive proposals will be reported to the Minnesota Attorney General for investigation and appropriate action.
4. Organizational Conflicts of Interest
To the best of Responder's knowledge and belief, and except as otherwise disclosed in Attachment 3 below,
Responder declares and certifies that there are no relevant facts or circumstances which could give rise to an
organizational conflict of interest.
5. Telecommunications Certification
Responder certifies that, consistent with Section 889 of the John S. McCain National Defense Authorization Act for
Fiscal Year 2019, Pub. L. 115-232 (Aug. 13, 2018), and 2 CFR 200.216, Responder will not use funding covered by this
RFP to procure or obtain, or to extend, renew, or enter into any contract to procure or obtain, any equipment,
system, or service that uses "covered telecommunications equipment or services" (as defined in Section 889 of the
John S. McCain National Defense Authorization Act) as a substantial or essential component of any system or as
critical technology as part of any system. Responder will include this certification as a flow down clause in any
contract related to this agreement.
6. Copyrighted Material Waiver
Responder certifies that it has obtained all necessary approvals for the reproduction and distribution of the contents
of its Proposal.
7. Disadvantaged Business Enterprises (DBE) Conscious Goal
Responder hereby recognizes that the following DBE conscious goal has been established for this RFP in accordance
with the Special Provisions posted with the RFP: Disadvantaged Business Enterprise-Neutral (DBEN). Responder
understands that MnDOT's Office of Civil Rights is required to evaluate the successful Responder's attainment of the
goal, or its Good Faith Efforts made to attain the goal, before a contract can be awarded. Responder understands
that failure to meet the goal or show Good Faith Efforts to meet the goal, will deem the successful Responder as
non-responsive, resulting in rejection of its Proposal.
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8. E-Verify Certification (In accordance with Minnesota Statutes 16C.075)
Responder certifies that, as of the date services are performed on behalf of MnDOT, Responder, as well as all of its
proposed subcontractors, will have implemented, or be in the process of implementing, the federal E-Verify
program for all newly hired employees in the United States who will perform work on behalf of MnDOT. If awarded
the contract, the Selected Responder will be responsible for collecting all subcontractor certifications and may do so
utilizing the E-Verify Subcontractor Certification Form available at
http://www.mmd.admin.state.mn.us/doc/EverifySubCertForm.doc. All subcontractor certifications must be kept on
file with the Selected Responder and made available to MnDOT upon request.
9. Certification of Nondiscrimination (In accordance with Minnesota Statutes 16C.053)
Responder certifies that it does not engage in, and has no present plans to engage in, discrimination against Israel,
or against persons or entities doing business in Israel, when making decisions related to the operation of the
vendor's business. For purposes of this section, "discrimination" includes, but is not limited to, engaging in refusals
to deal, terminating business activities, or other actions that are intended to limit commercial relations with Israel,
or persons or entities doing business in Israel, when such actions are taken in a manner that in any way
discriminates on the basis of nationality or national origin and is not based on a valid business reason.
10. Certification Regarding Lobbying.
For State of Minnesota contracts and grants over $100,000, Responder certifies, to the best of its knowledge and
belief that:
a. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person
for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of
any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal
contract, grant, loan, or cooperative agreement.
b. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing
or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee
of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or
cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, Disclosure Form to
Report Lobbying in accordance with its instructions.
c. The undersigned shall require that the language of this certification be included in the award documents for all
sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans and cooperative
agreements) and that all sub-recipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into and is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. 1352.
Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and
not more than $100,000 for each such failure.
11. Debarment and Suspension
Responder understands that because Federal money will be used (or may potentially be used) to pay for all or part
of the work under the contract, it is a covered transaction for purposes of 49 Code of Federal Regulations (CFR) Part
29, and that all lower tier covered transactions Responder enters into must include a requirement to comply with 49
CFR 29. Responder certifies that none of the contractor, its principals, as defined at 49 CFR 29.995, or affiliates, as
defined at 49 CFR 29.905, are excluded, or disqualified as defined at 49 CFR 29.940 and 29.945. Responder further
certifies as follows:
The certification in this clause is a material representation of fact relied upon by the MnDOT. If it is later determined
that the responder knowingly rendered an erroneous certification, in addition to remedies available to the MnDOT,
the Federal Government may pursue available remedies, including but not limited to suspension and/or debarment.
The responder agrees to comply with the requirements of 49 CFR 29, Subpart C while this offer is valid and
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throughout the period of any contract that may arise from this offer. The responder further agrees to include a
provision requiring such compliance in its lower tier covered transactions.
By signing this form, Responder acknowledges and certifies compliance with all applicable requirements indicated
above.
Authorized Signature
Responder's firm name: Vendor ID:
Printed name: Title:
Email: Telephone:
Authorized signature: Date (mm/dd/yyyy):
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ATTACHMENT 2: EXCEPTIONS TO MnDOT'S TERMS AND CONDITIONS
MnDOT presumes Responder agrees to the terms and conditions of this RFP unless Responder takes specific exception
to one or more of the conditions listed on this form. MnDOT reserves the right to reject, negotiate, modify, or accept
any of the proposed exceptions to MnDOT's terms and conditions.
As of July 1, 2025, certain terms are unenforceable in state contracts. See Session Laws, 2025 Regular Session, Chapter
39, Article 2, Section 45.
Unenforceable Terms
a. A contract entered into by the State will not contain a term that:
i. Requires the State to defend, indemnify, or hold harmless another person or entity, unless specifically
authorized by statute;
ii. Binds a party by terms and conditions that may be unilaterally changed by the other party;
iii. Requires mandatory arbitration;
iv. Attempts to extend arbitration obligations to disputes unrelated to the original contract;
v. Construes the contract in accordance with the laws of a State other than Minnesota;
vi. Obligations state funds in subsequent fiscal years in the form of automatic renewals as defined in section
325G.56; or
vii. Is inconsistent with Chapter 13, the Minnesota Government Data Practices Act.
b. If a contract is entered into that contains a term prohibited in paragraph (a), that term will be void and the
contract is enforceable as if it did not contain that term.
Please Note: exception requests that would cause the term(s) to become unenforceable pursuant to the above may
result in the disqualification of Responder's Proposal from further review and evaluation.
Responder must explicitly list below all proposed exceptions to MnDOT's terms and conditions, if any. Reference the
clause number and page number of each term or condition for which Responder desires an exception or modification
(add additional pages if necessary). If no proposed exceptions exist, clearly state "NONE" on the form below. Whether or
not exceptions are desired, Responder must sign and date this form and submit it as part of its Proposal.
Clause and Page
Suggested Change to Clause Explanation or Justification
Number
By signing this form, I acknowledge that the above-named Responder accepts, without qualification, all terms and
conditions stated in this RFP, including all of MnDOT's standard contract terms and conditions, except those clearly
outlined as proposed exceptions above.
Authorized Signature
Responder's firm name: Vendor ID:
Printed name: Title:
Email: Telephone:
Authorized signature: Date (mm/dd/yyyy):
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ATTACHMENT 3: RESPONDER FORMS
All forms incorporated into this Attachment must be completed and signed by Responder's duly authorized
representative and submitted with Responder's Proposal, unless otherwise noted.
Summary of Included Forms:
Resident Vendor Form
Conflicts of Interest Checklist and Disclosure Form
Federal Disclosure Form to Report Lobbying (Standard Form-LLL)
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WORKFORCE AND EQUAL PAY DECLARATIONS FORM
This form is required for all businesses executing government contracts under the following:
1. 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)
2. Select all that apply:
We are a Certificate holder:
Workforce Certificate under the name: _________________________________________________________

Workforce Certificate End Date: _________________________________
Equal Pay Certificate under the name: __________________________________________________________

Equal Pay Certificate End Date: _________________________________
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 and, if applicable, Equal Pay Certificate, or approved exemption by MDHR is required before a contract
can be executed.
We are Exempt:
We attest to MDHR that 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. MDHR 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.
Workforce Certificate End Date: _____________________
Equal Pay Certificate End Date: _____________________
Authorized Signature
Responder's firm name: Vendor ID:
Printed name: Title:
Email: Telephone:
Authorized signature: Date (mm/dd/yyyy):
For assistance with this form, email the Minnesota Department of Human Rights Compliance.MDHR@state.mn.us
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CONFLICT OF INTEREST CHECKLIST AND DISCLOSURE FORM
Purpose of this Checklist: This checklist is provided to assist Responders in screening for potential organizational
conflicts of interest. The checklist is for the internal use of Responders and does not need to be submitted to MnDOT,
however, the "Disclosure of Potential Conflict of Interest" form must be submitted with your Proposal.
Definition of "Responder": As used herein, the word "Responder" includes both the prime contractor and all proposed
subcontractors.
Checklist is not Exclusive: Please note that this checklist serves as a guide only, and that there may be additional
potential conflict situations not covered by this checklist. If a Responder determines a potential conflict of interest exists
that is not covered by this checklist, that potential conflict must still be disclosed.
Use of the Disclosure Form: Responders must complete the attached disclosure and submit it with their Proposal (or
separately, as directed by MnDOT, for projects not awarded through a competitive solicitation). If the Responder
determines a potential conflict of interest exists, it must disclose the potential conflict to MnDOT; however, such a
disclosure will not necessarily disqualify a Responder from being awarded a contract. To avoid any unfair "taint" of the
selection process, the disclosure form should be provided separate from the Proposal, and it will not be provided to
selection committee members. MnDOT's Contract Management personnel will review the disclosure and the
appropriateness of the proposed mitigation measures to determine if the Responder may be awarded the contract
notwithstanding the potential conflict. MnDOT's Contract Management personnel may consult with MnDOT's Project
Manager and Department of Administration personnel. By statute, resolution of conflict of interest issues is ultimately at
the sole discretion of the Commissioner of Administration.
Material Representation: Responders are required to submit the attached disclosure form either declaring, to the best
of its knowledge and belief, that no potential conflict exists, or identifying potential conflicts and proposing remedial
measures to ameliorate such conflict. The Responder must also update conflict information if such information changes
after the disclosure. Information provided on the form will constitute a material representation as to the award of this
contract. MnDOT reserves the right to cancel or amend the resulting contract if the Responder failed to disclose a
potential conflict, which it knew or should have known about, or if the Responder provided information on the
disclosure form that is materially false or misleading.
Approach to Reviewing Potential Conflicts: MnDOT recognizes that Responder's must maintain business relations with
other public and private sector entities in order to continue as viable businesses. MnDOT will take this reality into
account as it evaluates the appropriateness of proposed measures to mitigate potential conflicts. It is not MnDOT's
intent to disqualify Responders based merely on the existence of a business relationship with another entity, but rather
only when such relationship causes a conflict that potentially impairs the Responder's ability to provide objective advice
to MnDOT. MnDOT would seek to disqualify Responders only in those cases where a potential conflict cannot be
adequately mitigated. Nevertheless, MnDOT must follow statutory guidance on organizational conflicts of interest.
Statutory Guidance: Minnesota Statutes 16C.02, subdivision 10(a) places limits on state agencies' ability to contract
with entities having an "organizational conflict of interest." For purposes of this checklist and disclosure requirement,
the term "vendor" includes "Responder" as defined above. An "Organizational conflict of interest" means that because
of existing or planned activities or because of relationships with other persons: (1) the vendor is unable or potentially
unable to render impartial assistance or advice to the state; (2) the vendor's objectivity in performing the contract work
is or might otherwise be impaired; or (3) the vendor has an unfair advantage.
Additional Guidance for Professionals Licensed by the Minnesota Board of Engineering: The Minnesota Board of
Engineering has established conflict of interest rules applicable to those professionals licensed by the Board (see
Minnesota Rules Part 1805.0300). Subpart 1 of the rule provides "A licensee must avoid accepting a commission where
duty to the client or the public would conflict with the personal interest of the licensee or the interest of another client.
Prior to accepting such employment, the licensee must disclose to a prospective client such facts as may give rise to a
conflict of interest."
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An organizational conflict of interest may exist in any of the following cases:
1. The Responder, or its principals, own real property in a location where there may be a positive or adverse impact on
the value of such property based on the recommendations, designs, appraisals, or other deliverables required by
this contract.
2. The Responder, or its principals, in previous work for MnDOT has provided the final design or related services that
are directly related to performance of work required under this contract. Comment: this provision will, for example,
disqualify a Responder who performed final design for MnDOT and now seeks to provide construction
administration services for that same project. MnDOT believes this is necessary because the firm that prepared the
plans may be unable to objectively determine plan errors and omissions. This may cause a situation where: (1) the
vendor is unable or potentially unable to render impartial assistance or advice to MnDOT; and (2) the vendor's
objectivity in performing the contract work is or might otherwise be impaired.
3. The Responder is providing services to another governmental or private entity and the Responder knows or has
reason to believe, that entity's interests are, or may be, adverse to MnDOT's interests with respect to the specific
project covered by this contract. Comment: the mere existence of a business relationship with another entity would
not ordinarily need to be disclosed. Rather, this focuses on the nature of services commissioned by the other entity.
For example, it would not be appropriate to propose on a MnDOT project if a local government has also retained the
Responder for the purpose of persuading MnDOT to stop or alter the project plans.
4. This contract is for right-of-way acquisition services or related services (e.g. geotechnical exploration) and the
Responder has an existing business relationship with a governmental or private entity that owns property to be
acquired pursuant to this contract.
5. The Responder is providing real estate or design services to a private entity, including but not limited to developers,
whom the Responder knows or has good reason to believe, own or are planning to purchase property affected by
the project covered by this contract, when the value or potential uses of such property may be affected by the
Responder's performance of work pursuant to this contract. "Property affected by the project" includes property
that is in, adjacent to, or in reasonable proximity to current or potential right-of-way for the project. The value or
potential uses of the private entity's property may be affected by the Responder's work pursuant to the contract
when such work involves providing recommendations for right-of-way acquisition, access control and the design or
location of frontage roads and interchanges. Comment: this provision does not presume Responders know nor have
a duty to inquire as to all of the business objectives of their clients. Rather, it seeks the disclosure of information
regarding cases where the Responder has reason to believe that its performance of work under this contract may
materially affect the value or viability of a project it is performing for the other entity.
6. The Responder has a business arrangement with a current MnDOT employee or immediate family member of such
employee, including promised future employment of such person, or a subcontracting arrangement with such
person, when such arrangement is contingent on the Responder being awarded this contract. This item does not
apply to pre-existing employment of current or former MnDOT employees, or their immediate family members.
Comment: this provision is not intended to supersede any MnDOT policies applicable to its own employees
accepting outside employment. This provision is intended to focus on identifying situations where promises of
employment have been made contingent on the outcome of this particular procurement. It is intended to avoid a
situation where a Responder may have unfair access to "inside" information.
7. The Responder has, in previous work for MnDOT, been given access to "data" relevant to this procurement or this
project that is classified as "private" or "nonpublic" under the Minnesota Government Data Practices Act, and such
data potentially provides the Responder with an unfair advantage in preparing a Proposal for this project. Comment:
this provision will not, for example, necessarily disqualify a Responder who performed some preliminary work from
obtaining a final design contract, especially when the results of such previous work are public data available to all
other Responders. Rather, it attempts to avoid an "unfair advantage" when such information cannot be provided to
other potential Responders. Definitions of "government data", "public data", "non-public data" and "private data"
can be found in Minnesota Statutes Chapter 13.
8. The Responder has, in previous work for MnDOT, helped create the "ground rules" for this solicitation by performing
work such as: writing this solicitation, or preparing evaluation criteria or evaluation guides for this solicitation.
9. The Responder, or any of its principals, because of any current or planned business arrangement, investment
interest, or ownership interest in any other business, may be unable to provide objective advice to MnDOT.
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DISCLOSURE OF POTENTIAL CONFLICT OF INTEREST
Having had the opportunity to review the Organizational Conflict of Interest Checklist, the Responder indicates that it
has, to the best of its knowledge and belief:
Determined that no potential organizational conflict of interest exists.

Determined that a potential organizational conflict of interest exists, as follows:

Describe nature of potential conflict:
Describe measures proposed to mitigate the potential conflict:
If a potential conflict has been identified, please provide the name and phone number for a contact person authorized
to discuss this disclosure form with MnDOT contract personnel.
Name: Telephone:
Authorized Signature
Responder's firm name: Telephone:
Printed name: Title:
Authorized signature: Date (mm/dd/yyyy):
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