Certification Of Responsible Contractor Status (Page 4 of 4) in pdf

Certification Of Responsible Contractor Status Page 4

Responsible Contractor Worksheet

Company Name: ________________________________________________________

This worksheet has been provided to assist you with answering questions on the Certification of

Responsible Contractor Status form. The Responsible Contractor program encourages fair wages

and benefit, consistent with local market practices. Please take a few minutes to complete the

following questions about your firm and the marketplace in which you operate.

Wages

1. Considering the wages paid by your competitors in this market, the nature of this project,

and the size and scope of this contract, do you believe that your firm will pay local

market wages for your employees on this job?

 Yes

 No

Benefits

1. For your employees on this job, will your firm provide employer-paid health insurance

for the employee or the employee and his or her family?

 Yes

 No

2. For your employees on this job, will your firm provide pension, 401(k), or a similar

retirement savings or deferred compensation program?

 Yes

 No

3. For your employees on this job, will your firm provide access to apprenticeship programs

for skilled trades?

 Yes

 No

4. Are there any other benefits that you will provide to your employees on this job that you

would like to describe (e.g. paid vacation, sick leave, etc.)? If so, please describe:

________________________________________________________________________

_______________________________________________________________________

5. Considering your answers above, the benefits your competitors in this market provide to

their employees, the size and scope of this contract, and the nature of this project, do you

believe your firm will provide benefits consistent with local market practices to your

employees on this job?

 Yes

 No

Please attach additional pages if you would like to elaborate on any of the answers you

provided above.

Certification Of Responsible Contractor Status Page 4