Laserfiche WebLink
<br /> 5:1H <br /> Exhibit 0 Page 18 <br /> COUNTY OF SAN MATEO <br /> Equal Benefits Compliance Declaration Form <br /> I Vendor Identification <br /> Name of Contractor: ~."')(~ CL~~~~\ j)i~\-r-\c t- <br /> Contact Person: <br /> Address: IAi\'€j- -:> ""02:._C~ <br /> 1Sl'}Kra(\ ~~ Sr' <br /> Phone Number: '\<pc.\. (.'JcXlA 0 ~~, (I A q <f Ob-3 <br /> bc:;n -"-I a::3 -.,;;l..al-..)./ <br /> Fax Number: 10 <:'0 - ~ (Q 'r - ;A \ 8".?; <br /> II Employees <br /> Does the Contractor have any employees? 0 Yes 0 No <br /> Does the Contractor provide benefits to spouses of employees? f?J Yes 0 No <br /> "If the answer to one or both of the above is no, please skip to Section IV." <br /> III Equal Benefits Compliance (Check one) <br /> 12].. Yes, the Contractor complies by offeririg 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 /> o No, the Contractor does not comply. <br /> o The Contractor is under a coll~ctive bargaining agreement which began on <br /> (date) and expires on (date). <br /> IV Declaration <br /> I declare under penalty of perjury under the laws of the State of California that the foregoing is <br /> tr d correct, and that I am authorized to bind this entity contractually. <br /> 3'"OJ) Chr\'.s~sen <br /> Name (Please Print) <br /> s'r Iferi f\ -t-e./\de....f\ +- k:, -6l. '('"-0 Co <br /> - . Title Date <br /> -...< <br />