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6.1 B Page 18 Attachment ill County of San Mateo Contractor's Declaration Form I. CONTRACTOR INFORMATION Con#ractor Name: Ciry of Redwood CitylFair Oaks Community Phone; (650) 780-7510 Center Contact Person: Teri Chin, Human Services Mana er Fax: 650 298-8184 Address: 2600 Middle#ield Road Redwood Cit , CA 94063 II. EQUAL BENEF 1TS (check one or more boxes) Contractors with contracts in excess of $5,000 must #reaf spouses and domestic partners equaAy as fo employee benefits. f" Contractor complies with the County's Equal Benefits Ordinance by: f" offering equal benefits to employees with spouses and employees with domestic partners. t'" offering a cash equivalent payment to eligible employees in lieu of equal benefits. I- Contractor does not comply with the County's Equal Benefits Ordinance. ~" Contractor is exempt from this requirement because: F... Contractor has no employees, does nat provide benefits to employees' spouses, or the contract is for $5,000 or less. 1.- Contractor is a party to a collective bargaining agreement that began on (date) and expires on (date), and intends.to offer equal benefits when said agreement expires, III. NON-DISCRIMINATION (check appropriate box) Finding(s) of discrimination have been issued against Contractor within the past year by the Equal Employment f ~ Opportunity Commission, Fair Employment and Housing Commission, or other investigative entity. Please see aitached sheet of paper explaining the outcome(s) or remedy for the discrimination. No finding of discrimination has been issued in the past year against the Contractor by the Equal Employment Opportunity Commission, Fair Employment and Housing Commission, or any other entity. IV. EMPLOYEE J URY SERVICE (check one or more boxes) Confractors with original or amended contracts in excess of $100,00D must have and adhere to a written policy that provides its employees living in San Mafeo County up to frve days regular pay for actual jury service in the Counfy, i= Contracfor complies with the County's Employee Jury Service Ordinance. Contractor does not comply with the County's Employee Jury Service Ordinance. r Contractor is exempt from this requirement because: the contract is for $100,000 or less. r Contractor is a parry to a collective bargaining agreement that began on (da#e) and expires on _ (date), and intends to com ply when the collective bargaining agreement expires. 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. Signature Name Date Title 8-7-06 Page 1 of 1