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Equal Benefits Compliance Declaration <br /> <br />I Vendor Identification <br /> <br /> Name of Contractor: FAIR OAKS COMMUNITY CENTER - CITY OF REDWOOD CITY <br /> <br /> Contact Person: Teri Chin <br /> <br /> Address: 2600 Middlefield Road <br /> Redwood City, CA 94063 <br /> <br /> Phone Number: (650) 780-7500 Fax Number: (650) 298-8184 <br /> <br />II Em ployees <br /> <br /> Does the Contractor have any employees? ~ Yes No <br /> <br /> Does the Contractor provide benefits to spouses of employees? ~x Yes No <br /> <br />III Equal Benefits Compliance (Check one) <br /> <br /> ~1 Yes, the Contractor compiles by offering equal benefits, as defined by Chapter 2.93, to its <br /> employees with spouses and its employees with domestic partners. <br /> ~1 Yes, the Contractor complies by offering a cash equivalent payment to eligible employees in lieu <br /> of equal benefits. <br /> ~ No, the Contractor does not comply. <br /> gl The Contractor is under a collective bargaining agreement which began on *2//0 1 (date) and <br /> expires on ~/~,/oq (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 true <br /> and correct, and that I am authorized to bind this entity contractually. <br /> <br /> Executed this day of ,20__ at ~ <br /> (City) (State) <br /> <br /> Signature Name (please print) <br /> <br /> 94-6001116 <br /> Title Contractor Tax Identification Number <br /> <br /> C :~_Rosa MendozahMy Docu ments~C ON TRACT~F air Oaks~Fair Oaks a gr ~.v. qpd <br /> form re',', lun¢ 28, 2002 Page 20 of 20 <br /> <br /> <br />