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<br />6.1C <br />Page 13 <br /> <br />Exhibit C <br />Equal Benefits Compliance Declaration Form <br /> <br />I Vendor Identification <br /> <br />Phone Number <br /> <br />Fax Number <br /> <br />First Community Housing <br />Geoff Morgan <br />2 North 2nd Street Suite 1250 <br />San Jose, CA 95113 <br />408-291-8650 <br />408-993-9098 <br /> <br />Name of Contractor <br />Contact Person <br />Address: <br /> <br />II Employees <br /> <br />Does the Contractor have any employees? . Yes. No <br /> <br />Does the Contractor provide benefits to spouses of employees? . Yes. 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 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 in <br />lieu of equal benefits. <br />. No, the ContracfDr does not comply. <br />. 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 Califomia that the foregoing is true <br />and correct, and that I am authorized to bind this entity contractually. <br /> <br />Signature <br /> <br />Name (Please Print) <br /> <br />Date <br /> <br />Title <br /> <br />Contract VM <br /> <br />11 <br />