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<br />6.18 <br />Page 19 <br /> <br />Exhibit D <br /> <br />County of San Mateo <br />Contractor's Declaration Form <br /> <br />I. CONTRACTOR INFORMA TlON <br /> <br />Contractor Name: City of Redwood City Phone: (650) 780-7301 <br />Contact Person: Peter Inqram, City Manaqer Fax: (650) 780-7225 <br />Address: 1017 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 <br />benefits. <br /> <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 />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 />C' Contractor has no employees, does not provide benefits to employees' spouses, or the contract is for $5,000 <br />or less. <br /> <br />r <br /> <br />Contractor is a party to a collective bargaining agreement that began on _ (date) and expires on_ <br />(date), and intends to offer equal benetits when said agreement expires. <br /> <br />/fl. NON-DISCRIMINA TION (check appropliate box) <br /> <br />Finding(s) of discrimination have been issued against Contractor within the past year by the Equal <br />r Employment Opportunity Commission, Fair Employment and Housing Commission, or other investigative <br />entity. Please see attached sheet of paper explaining the outcome(s) or remedy for the discrimination. <br /> <br />r <br /> <br />No finding of discrimination has been issued in the past year against the Contractor by the Equal <br />Employment Opportunity Commission, Fair Employment and Housing Commission, or any other entity. <br /> <br />IV. EMPLOYEE JURY SERVICE (check one or more boxes) <br /> <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 /> <br />C Contractor complies with the County's Employee Jury Service Ordinance. <br />r Contractor does not comply with the County's Employee Jury Service Ordinance. <br /> <br />C Contractor is exempt from this requirement because: <br /> <br />C the contract is for $100,000 or less. <br /> <br />e 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, and <br />that I am authorized to bind this entity contractually. <br /> <br />Signature <br /> <br />Name <br /> <br />Date <br /> <br />Title <br /> <br />17 <br />