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<br />$Z7 <br /> <br />ATTACHMENT IV <br /> <br />COUNTY OF SANMA TEO <br />Equal Benefits Compliance Declaration Form <br />City of Redwood City <br /> <br />I Vendor Identification <br /> <br />Phone Number <br />Fax Number <br /> <br />City of Redwood City <br />Ed Everett <br />1017 Middlefield Road <br />Redwood City 94063 <br />(650) 780-7300 <br />(650) 780-7225 <br /> <br />Name of Contractor <br />Contact Person <br />Address: <br /> <br />II Employees <br />Does the Contractor have any employees? 0 Yes 0 No <br /> <br />Does the Contractor provide benefits to spouses of employees? 0 Yes 0 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 />0 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 />0 Yes, the Contractor complies by offering a cash equivalent payment to eligible employees <br />in lieu of equal benefits. <br />0 No, the Contractor does not comply. <br />0 The Contractor is under a collective bargaining agreement which began on <br /> <br />(date) , and expires on <br /> <br />(date). <br /> <br />IV Declaration <br /> <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 /> <br />Name (Please Print) <br /> <br />Signature <br /> <br />Date <br /> <br />Title <br /> <br />24 <br /> <br />