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<br />Exhibit C <br />COUNTY OF SAN MATEO <br />Equal Benefits Compliance Declaration Form <br /> <br />I Vendor Identification <br /> <br />Phone Number: <br />Fax Number: <br /> <br />City of Redwood City - Fair Oaks Community Center <br />Teri Chin, Executive Director <br />1017 Middlefield Road <br />Redwood City, CA 94064 <br />fifiO-7RO -7:\ç¡~ <br /> <br />Name of Contractor: <br />Contact Person: <br />Address: <br /> <br />II Emplovees <br />Does the Contractor have any employees? ~ Yes D No <br /> <br />Does the Contractor provide benefits to spouses of employees? gYes D No <br /> <br />(If the answer to one or both of the above is no, please skip to Section IV). <br /> <br />III Equal Benefits Compliance (Check one) <br /> <br />~'Yes, the Contractor complies by offering equal benefits, as defined by Chapter <br />2.93, to its employees with spouses and its employees with domestic partners. <br />D Yes, the Contractor complies by offering a cash equivalent payment to eligible <br />employees in lieu of equal benefits. <br />D No, the Contractor does not comply. <br />D The Contractor is under a collective bargaining agreement which began on <br /> <br />(date), and expires on (date) <br /> <br />IV Declaration <br /> <br />I declare under penalty of perjury under the laws of the State of California that the <br />foregoing 's true rect, and that I am authorized to bind this entity contractually. <br /> <br />Te,y, Ch,\,"\ <br />Name (Please Print) <br /> <br />q /3-ç/ó-r; <br />'Date ' <br /> <br /> <br />Signature <br /> <br />l+-u_rY\CU'\ S^eY\J I (-es K()4\L\.C'~Y <br />Title <br />