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<br />Exhibit 0 <br /> <br />COUNTY OF SAN MATEO <br /> <br />Equal Benefits Compliance Declaration Form <br /> <br />Vendor Identification <br /> <br />Phpne Number: <br />Fax Number: <br /> <br />~~ u.')(')r~\. C;'~S0J'\CD \ -:Di'C>-\-r-, c \- <br />\<nrif"\ ~\\-ej orrl?3.ro2:.-c...A.- <br />'1 srI Rro. c1 ~ i-c\ Sr-. <br />'KF-c\.. ( I J c:::-D,.{ (' L ~ l CIA q tf 0 E<~:> <br />10"50 -1..\ a -:-:3 -~ d.. h y" <br />b~o.- ~br--~' ~() <br /> <br />Name of Contractor: <br />Contact Person: <br />Address: <br /> <br />II Employees <br />Does the Contractor have any employees? IiI Yes 0 No <br />Does the Contractor provide benefits to spouses of employees? fiQ Yes 0 No <br /> <br />*If the answer to one or both of the above is no, please skip to Section IV. * <br /> <br />III Equal Benefits Compliance (Check one) <br /> <br />I2l- 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 />o Yes, the Contractor complies by offering a cash equivalent payment to eligible employees <br />in lieu of equal benefits. <br />D No, the Contractor does not comply. <br />D The Contractor is under a collective bargaining agreement which began on <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 foregoing is <br />~4thorized to bind this entity cOnlract~aIlY. <br /> <br />~a(} Chr\'s-r--en Se. n <br />Signature Name (Please Print) <br /> <br />'~llreri {\ -t-e.(\6e..f\-t- <br />Title <br /> <br /><6 -DZ- ~-O b <br />Date <br />