Laserfiche WebLink
<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 City/Fair Oaks Community Phone: (650) 780-7510 <br /> Center <br />Contact Person: Teri Chin, Director 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 />rt 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 />offering a cash equivalent payment to eligible employees in lieu of equal benefits. <br />Contractor does not comply with the County's Equal Benefits Ordinance. <br />Contractor is exempt from this requirement because: <br />Contractor has no employees, does not provide benefits 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 />(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 />rI 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 />provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County. <br /> <br />i. Contractor complies with the County's Employee Jury Service Ordinance. <br />S Contractor does not comply with the County's Employee Jury Service Ordinance. <br />~ C~tractor is exempt from this requirement because: <br />rl the contract is for $100,000 or less. <br />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 />iin{ZOoh <br /> <br />_7~ I fJctf-AM <br /> <br />Name <br /> <br />Date <br /> <br />~ <br /> <br />I pfe}t j-Wl C, bf----ltl ~Jit)e'l <br />Title <br /> <br />8-7-06 <br /> <br />Page 1 of 1 <br />