AgdaPkt 2019-01-28 Joint SA PFA - Laserfiche WebLink

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6.D. - Page 116 of 170 EBO COMPLIANCE SECTION 3. COMPLIANCE OPTIONS I have read and understand the provisions of the Equal Benefits Ordinance and have determined that this company will comply as indicated below: ❑....... I have no employees. ❑....... I provide no benefits. ❑ ....... I provide benefits to employees only. Employees are prohibited from enrolling their spouse or domestic partner. 1k...... I provide equal benefits as required by the City of Los Angeles EBO. ❑....... I provide employees with a "Cash Equivalent." Note: The "Cash Equivalent" is the amount of money equivalent to what your company pays for spousal benefits that are unavailable for domestic partners, or vice versa. ❑....... All or some employees are covered by a collective bargaining agreement (CBA) or union trust fund. Consequently, I will provide Equal Benefits to all non-union represented employees, subject to the EBO, and will propose to the affected unions that they incorporate the requirements of the EBO into their CBA upon amendment, extension, or other modification of the CBA. ❑....... Health benefits currently provided do not comply with the EBO. However, I will make the necessary changes to provide Equal Benefits upon my next Open Enrollment period which begins on (Date) ❑....... Our current company policies, i.e., family leave, bereavement leave, etc., do not comply with the provisions of the EBO. However, I will make the necessary modifications within three (3) months from the date of this affidavit. SECTION 4. DECLARATION UNDER PENALTY OF PERJURY I understand that I am required to permit the City of Los Angeles access to and upon request, must provide certified copies of all company records pertaining to benefits, policies and practices for the purpose of investigation or to ascertain compliance with the Equal Benefits Ordinance. I will notify the City's Designated Administrative Agency if any changes are made that will affect our compliance with the Equal Benefits Ordinance. Furthermore, I understand that failure to comply with LAAC Section 10.8.2.1 et seq., Equal Benefits Ordinance may be deemed a material breach of any City contract by the Awarding Authority. The Awarding Authority may cancel, terminate or suspend in whole or in part, the contract; monies due or to become due under a contract may be retained by the City until compliance is achieved. The City may also pursue any and all other remedies at law or in equity for any breach. The City may use the failure to comply with the Equal Benefits Ordinance as evidence against the Contractor in actions taken pursuant to the provisions of the LAAC Section 10.40, et seq., Contractor Responsibility Ordinance. IWC PUbWLAEsr906A WMPIA4 will comply with the Equal Benefits Ordinance requirements as Company Name indicated above prior to executing a contract with the City of Los Angeles and will comply for the entire duration of the contract(s). I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that I am authorized to bind this entity contractually. Executed this day of ,I la N E , in the year 20, at V (City) (State) L�►.�. A587- Mi NESS P"kUJ 191 Signature Mailing Address CHRSRLES a. KAuF1)g1619 Name of Signatory (please print) P8 E&_ 051UT Title Form OCC/EBO-Affidavit (Rev 4/16/15) m meo NV, F9ya 3 City, State, Zip Code I8 -la 9 9Ly i EIN/TIN 2 199