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<br /> 6.1G <br /> Page 11 <br /> Exhibit C <br /> COUNTY OF SAN MATEO <br /> Equal Benefits Compliance Oeclaration Form <br /> I Vendor Identification <br /> Name of Contractor: City of Redwood City - Fair Oaks Community Center <br /> Contact Person: Terj Chin, Executive Director <br /> Address: 2600 M iddlefield Road <br /> Redwood City, CA 94064 <br /> Phone Num bar: (A SO) 7RO -' 7510 <br /> Fax Number: (FiSO) ?QR - Ri R4 <br /> II Emplovees <br /> Does the Contractor have a ny employees? ~ Y es 0 No <br /> Does the Contractor provide bene fits to spouses of employees? SYes 0 No <br /> (If the answer to one or both of the above is no, please skip to Section IV). <br /> III Eaual Benefits comDliance (Check one) <br /> E( Yes, the Contractor complies by offering equal benefits, as defined by Chapter <br /> 2.93, to its employees with spouses and its employees with domestic partners. <br /> o Yes, the Contractor complies by offering a cash equivalent payment to eligible <br /> employees in lieu of equal benefits. <br /> o No, the Contractor does not comply. <br /> o The Contractor is under a collective bargaining agreement which began on <br /> (date), and expires on (date) <br /> IV Declaration <br /> I declare under penalty of pe~ury under the laws of the State of California that the <br /> foregoing is true and correct, and that I am authorized to bind this entity contractually. <br /> Signature Name (Please Print) <br /> Title Date <br /> -. "-~.~ <br />