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6.1 D <br /> Page 16 <br /> Exhibit C <br /> Contractor's Declaration Form <br /> I. CONTRACTOR INFORMATION <br /> Contractor Name: C' of Redwood " Fair Daks Commun' Center Phone: 650-780-7510 <br /> Contact Person: Te�i Chin F�� <br /> Address: <br /> 2600 mlddlefie! Rd. <br /> Redwood ,cA 94063 <br /> II. EQUAL BENEFRS (chedc one or more boxes) <br /> Contracio�s wiih contracts in excess of $5,000 musl treat spouses and domes�c partners equally as io employee benefits. <br /> r" Contractor comFlies wrth the County's Equa! Benefrts Ordinance by: <br /> J offering equal benefrts to employees wlfh spouses and employees with domestrc partners. <br /> � offering a cash equivalent payment to elJg�le empbyees In Heu of equal bene�fs. <br /> r" Conbactor does rrot comply wifh the County's FqaalBer�e�ts O�iinance. <br /> �"' Contractor ls exempt from this requirement because: <br /> � Contractorhas no employees, does �of provide berwfrts fo employees'spouses, or the oontract is for $5,000 or less. <br /> r <br /> r Contractor is a party to a co!lective barga�ning agreement fhat began on (date) and expfr�s on (dateJ, and intends to offer equsl <br /> �� <br /> bene!'ds when said agreement expires. <br /> III. NON-DISCRIMINATION (check aaaropriate boxl <br /> Find'rng(s) of d�scrimination have been issued against Cor►fractor wifhin fhe past year by the Equa! Fmployment Opportunity Commission, Fair <br /> r� �mpbyment and Housfig Commissior►, or other fivestigatrve entity. Please see a�ached sheet of paper explafiing the outcome(s) or remedy for the <br /> discrfmination. <br /> ��-- No �nding of discrrmination has been Issued fi fhe past yeer agarnst the Conbactor by the Equel Empioyment Oppor[unrty Commission, Falr <br /> Emplayment and Nousing Commfssbn, or any other entity. <br /> IV EMPLOYEE JURY SERVICE (chedc one or more boxesl <br /> Contractors with original or amended cantracts in excess of $100,000 must have and adhere to a written policy that provides it� employees living � San Mateo County <br /> up to five days �egular pay (or actual jury service in the County. <br /> f Contractor complies with the County's Employee Jury Senrice Ordinance. <br /> � Confractor does not compty wlt� the Counry's Employee Jury Service Ordrnance. <br /> � Contrector Is exempt from fhls requlremer�t 6acause: <br /> � the contrect ts for$100,000 orless. <br /> � Cantrector is a party to a collectrve banpeining agreement fhat began an (dete) and expires on (date), and interrds to cornply urhen fhe <br /> r collective bargalnirrg agreement expires. <br /> I dedare under penalty af perjury under the laws of the State a( Califomia that the foregoing is Vue and correct, and that I am authorized ta bind thls en5ty contractuapy. <br /> Signature Name <br /> Date Title <br /> DOH Rev. September. 2010 <br /> FOCC $15,000 CDBG <br /> Page 14 of 21 <br />