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<br />Exhibit C <br />COUNTY OF SAN MATEO <br />Equal Benefits Compliance Declaration Form <br /> <br />Vendor Identification <br /> <br />Phone Num ber: <br />Fax Number: <br /> <br />City of Redwood City - Fair Oaks Community Center <br />Teri Chin, Executiye Director <br />2600 M iddlefield Road <br />Redwood City CA 94064 <br />(6110) 7RO -' 71110 <br />(R110) ?~R - R1 R4 <br /> <br />Name of Contractor: <br />Contact Person: <br />Address: <br /> <br />II Emplovees <br /> <br />Does the Contractor have a ny employees? ~ Yes 0 No <br /> <br />Does the Contractor provide benefits to spouses of employees? ~ Yes 0 No <br /> <br />(If the answer to one or both of the above is no, please sk ip to Section IV). <br /> <br />III Eaual Benefits Compliance (Check one) <br /> <br />'.8[ 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 />o Yes, the Contractor complies by offering a cash equivalent payment to eligible <br />employees in lieu of equal benefits. <br />o No, the Contractor does not comply. <br />o The Contractor is under a collective bargaining a greement 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 />foregoin I~ ;d corre ~and that I am authorized to bind this entity contractually. <br /> <br />/'" !/Cc / Eo E Vt~ <br />Signature Name (Please Print) <br /> <br />({7 /lJ,"'/fG6e/ ~0~ <br />Title Oat <br /> <br />Attest:~' ... "" h. ,~ <br />Patricia Howe, City Clerk <br />