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COUNTY OF SAN MATEC <br /> EquaTBenefits Compliance DeclaratTon Form <br /> <br />I Vendor Identification <br />Name 0f Contractor: City of Redwood City - Hur~an Resources <br />Contact Person: Maria Rivera-Pena, Human Resources Director <br />Address: 1017 Middlefield Road <br /> Redwood City, CA 94063 <br /> <br /> Phone Number. (650) 780-7287 Fax Number: <br /> <br />I I Employees <br /> <br /> Does the Contractor have any emploYees? ~ Yes [] No <br /> Does the Contractor'provide benefits to spouses of employees? ::~ Yes [] No <br /> *If the answer to one or both of the above is no, please skip to Section IV,* <br /> <br /> ill 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 offedng a cash equivalent payment to eligible employees <br /> in lieu of equal benefits. <br /> [] No, the Contractor does net comply. <br /> :[~ The Contractor is under a collective bargaining agreement which began on or before <br /> July 1, 2001 and expires on 1/31/04 . (Section 2.93:050 <br /> (date). <br /> <br /> IV Declaration <br /> I declare under penalty of perJury under the laws of the Sta. te of California that the foregoing is <br /> true and correct, and that I am authorized to bind this entity contractually. <br /> <br /> Executed this 26th dayof ~August ,2.002 at Redwood City,, CA <br /> <br /> ~j~ Maria Rivera-Pena <br /> · -' ' Sigr~j['u~e~ - - · Name· (Please Print) <br /> Human Resources Director ~94-6001116 <br /> Title Contractor Tax Identification Number <br /> <br /> <br />