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<br />6.1D <br />Page 8 <br /> <br />Attachment I <br />County of San Mateo <br />Contractor's Declaration Form <br /> <br />I. CONTRACTOR INFORMATION <br /> <br />Contractor Name: City of Redwood CitylFair Oaks Community Phone: (650) 780-7510 <br /> Center <br />Contact Person: T eri Chin, Director Fax: (65O) 298-8184 <br />Address: 2600 Middlefield Road I <br /> Redwood City, CA 94063 <br /> <br />II. EQUAL BENEATS (check one or more boxes) <br />Contractors with contracts in exC8SS of $5,000 must treat spouses and domesNc partners equally as to employee benefits, <br />r Contractor complies with the County's Equal Benefits Ordinance by: <br />r offering equal benefits to employees with spouses and employees with domestic partners. <br />G 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 />C, Contractor is exempt from this requirement because: <br />r Contractor has no employees, does not provide benefrts to employees' spouses, or the contract is for $5,000 <br />or less. <br />Contractor is a party to a collective bargaining agreement that began on _ (date) and expires on _ <br />r (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 />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 />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 />c <br /> <br />r <br /> <br />IV. EMPLOYEE JURY SERVICE (check one or more boxes) <br />Contractors with original or amended contracts in excess of $1 00,000 must have and adhere to a written policy that <br />provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County. <br />r 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 />C Contractor is exempt from this requirement because: <br />r 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 />Signature <br /> <br />Name <br /> <br />Date <br /> <br />Title <br /> <br />8-7.Q6 <br /> <br />Page 1 of 1 <br />