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AgdaPkt 2004-08-09
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AgdaPkt 2004-08-09
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Last modified
7/16/2012 4:10:55 PM
Creation date
8/5/2004 1:34:45 PM
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Template:
CC Index
CC Index - Document Type
Agenda Packet
Date
8/9/2004
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5.11�-1�r <br /> Exhibit C <br /> COUNTY OF SAN MATEO <br /> Equal Benefits Compliance Declaration Form <br /> I Vendor ldentification <br /> Name of Contractor: Citv of Redwood Citv <br /> Contact Person: Teri Chin <br /> Address: 2600 Middlefield Road <br /> Redwood City�CA 94063 <br /> Phone Number. fv50-7Rn-73a3 <br /> Fax Number: <br /> II Emplovees <br /> Does the Contractor have any employees? ❑ Yes ❑ No <br /> Does the Contractor provide benefits to spouses of employees? ❑ Yes ❑ No <br /> "'If the answer to one or both of the above is no, please skip to Section IV.` <br /> III EQUaI Benefits Comaliance (Check one) <br /> ❑ Yes, the Contractor complies by offering equal benefits, as defined by Chapter 2.93, to its <br /> employees with spouses and its employees with domestic partners. <br /> ❑ Yes, the Contractor complies by offering a cash equivalent payment to eligible employees <br /> in lieu of equal benefits. <br /> ❑ No, the Contractor does not comply. u-reer�nex�rs <br /> [.The Contractor is under a collective bargaining �es�e+�t which began on Qctrbur j, a0G � <br /> (date) , and expires on Sr��-r,►�� 3� , �pp � (date) � <br /> c�.nc b�ya;� or, F�; u��c j t, "�CC�y , cu�c.i �,c p��r�5 0:� 7w-►u�.; �j 3( ,�C�O$ <br /> IV Declaration <br /> I declare under penalty of perjury under the laws of the State of California that the foregoing is <br /> true and correct, and that I am authorized to bind this entity contractually. <br /> Signature Name (Please Print) <br /> Title Date <br /> 13 <br />
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