Laserfiche WebLink
<br />Attachment III <br />County of San Mateo <br />Contractor's Declaration Form <br /> <br />I. CONTRACTOR INFORMATION <br /> <br />Contractor Name: City of Redwood City/Fair Oaks Community Phone: (650) 780-7510 <br /> Center <br />Contact Person: Teri Chin, Human Services Manaqer Fax: (650) 298-8184 <br />Address: 2600 Middlefield Road <br /> Redwood City, CA 94063 <br /> <br />II. EQUAL BENEFITS (check one or more boxes) <br />Contractors with contracts in excess of $5, 000 must treat spouses and domestic partners equally as to employee benefits. <br />rf Contractor complies with the County's Equal Benefits Ordinance by: <br />rI offering equal benefits to employees with spouses and employees with domestic partners. <br />r offering a cash equivalent payment to eligible employees in lieu of equal benefits. <br />r Contractor does not comply with the County's Equal Benefits Ordinance. <br />r Contractor is exempt from this requirement because: <br />r Contractor has no employees, does not provide benefits to employees' spouses, or the contract is for $5,000 <br />or less. <br />r Contractor is a party to a collective bargaining agreement that began on _ (date) and expires on_ <br />(date), and intends to offer equal benefits when said agreement expires. <br /> <br />III. NON.DISCRIMINATION (check appropriate box) <br />Finding(s) of discrimination have been issued against Contractor within the past year by the Equal Employment <br />r Opportunity Commission, Fair Employment and Housing Commission, or other investigative entity. Please see <br />attached sheet of paper explaining the outcome(s) or remedy for the discrimination. <br />Ii'" No finding of discrimination has been issued in the past year against the Contractor by the Equal Employment <br />Opportunity Commission, Fair Employment and Housing Commission, or any other entity. <br /> <br />IV. EMPLOYEE JURY SERVICE (check one or more boxes) <br />Contractors with original or amended contracts in excess of $100,000 must have and adhere to a written policy that <br />pro~des its employees living in San Mateo County up to five days regular pay for actual jury service in the County. <br />!t Contractor complies with the County's Employee Jury Service Ordinance. <br />C/ Contractor does not comply with the County's Employee Jury Service Ordinance. <br />r: C9'1tractor is exempt from this requirement because: <br />!L the contract is for $100,000 or less. <br />r Contractor is a party to a collective bargaining agreement that began on _ (date) and expires on_ <br />(date), and intends to comply when the collective bargaining agreement expires. <br /> <br />I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, <br />and that I am authorized to bind this entity contractually. <br /> <br />2 ~czJ ~~ <br />- 1t;~7 <br /> <br />(\ ~. <br />Att t~~":' '- 'S' ... ~ . ~ ~ \.. \> J <br />es. . <br />Patricia Howe, City Clerk <br /> <br />Date <br /> <br />-Ww C\ V d /tvevett- <br /> <br />Name <br /> <br />Ghj ~CW)ase( <br />Title . <br /> <br />8-7-06 <br /> <br />Page 1 of 1 <br />