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6.D. - Page 105 of 170 Request for Qualifications: General Park Building Construction, Retrofit, Maintenance, and/or Repairs CITY OF LOS ANGELES I FORM D VENDOR CHILD CARE POLICY PROGRAM CHILD CARE DECLARATION STATEMENT The business concern listed below declares the following status on the "Child Care Policy of the City of Los Angeles, XI. Vendors" as defined in the attached supplementary instructions to bidders. It is incumbent upon the concern to notify the City of any changes .applicable to this declaration. ,�� omv\ VAq fig- m- wo Business Name Telephone No. aw JA6ws`Q &gA\ Nuv, � N X23 Business Address IMPORTANT — RESPONDERS MUST SUBMIT ALL REQUIRED FORMS (COMPLETELY FILLED OUT) BY RFQ SUBMITTAL DEADLINE. Page 98 of 103 188 Signature Title Note: A "stated child care policy" may include services and/or benefits for employees and their families, including infants through school- age child care centers or family day care homes, before and after school programs, day camps, and services for ill children with special needs, family leave, and more. Please refer to the attached instructions for definitions. Please check ALL items on the form that apply to your business concern. Part One YES NO DOES YOUR BUSINESS HAVE A STATED CHILD CARE POLICY? ❑ If YES, please attach a copy ❑ Part Two DOES YOUR BUSINESS PROVIDE CHILD CARE ASSISTANCE? If YES, please check which from(s) of assistance ❑ Level I Assistance Subsidized company child care center homes El Subsidized Network of child care Child care reimbursement in addition to other benefits ❑ Child care reimbursement in a flexible benefit package Paid parental leave E �N �10 Purchase of spaces for employees in community child care program(s) (centers or homes) El II Assistance 125 Salary set aside/flexible spending account funded with employee salary dollars/Section ❑ Child care referral services ❑ Parenting seminars issues ❑ Counseling on work/family ❑ %1 Start-up of a self-supporting center Start-up contributions to a "consortium center" ❑ Level III Assistance Flexible work hours ❑ Flex-place/work-at-home El part-time/job sharing El Work -at-home following maternity leave ❑ Unpaid parental leave Donations to enhance child care programs Other: (Describe) I HAVE R n D AND COMPLETED: j/ I to (Signed) (Date) For additional information on child care options and benefits for employees, please contact the City Child Care Coordinator's Office, 333 South Spring Street, Los Angeles, CA 90013. Do not write in this space Date Filed: Expiration Date: 50-184 (11/89) IMPORTANT — RESPONDERS MUST SUBMIT ALL REQUIRED FORMS (COMPLETELY FILLED OUT) BY RFQ SUBMITTAL DEADLINE. Page 98 of 103 188