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County of San Mateo � <br /> Cotntactor's DeclaraUon Form <br /> L CONTRACTORINFORMATION • <br /> ConhachorName: C ofRedwood C' Phone: 850-780-7301 <br /> CoMect Person: Robert B. Bell Fau: 850-298-8184 <br /> Add�ess: CNy HeA 1017 Middlefield Rd <br /> Redxrood C , CA 94063 <br /> tl. EQUAL BENEFITS (check otre or rtare boxes) <br /> Corrtra� wilh conhacGs 'm excess o($5,000 must 6eat spouses and domestic partners equally as to empbyee beneNts. <br /> ontractor complies wilh the Countys Equal Beneflls Ordinance by: <br /> � oftering equal beneftts to empbyees w(th spouses and empbyees with domestic paMers. <br /> %Re�ng a cash equiveleM payment to elig�ble employees in Ifeu of equal benefils. <br /> Contractor does not aomply with the CouMys Equel BeneAts OrdNsr�ce. <br /> ContracOor is exempt fmm this requiremeM because: <br /> ContracOor h� no empbyees, do� rrot provide beneflls to empbyees' spouses, or the con4ad is Tor $5,000 <br /> or less. <br /> ConUacOor is a party ho a co0e¢five beigaining egreement that began on _(dete) and e�ires on _(daUe), <br /> arM intends in ofier equal beneflts when said agreemeM e�ires. <br /> nl. NON�DISCRIMIItATION (c�eck appropriate box) ,� <br /> ���AIg) � dbcdminatbn have been iswed against Contrador wfihin the past year by Ure Equal Empbyment <br /> OpporWniqr Commission, Fair EmpbymeM and Housing Commission, or ottrer investlgative entity, Please see <br /> a�ch� sheet ot p�er expleining the outcome(s) or remedy tor tl�e dis�ximination. <br /> .�/No 6nd'mg of d'spimi�n has been issued in tlie past year against the Contractor by tlie Equal EmploymeM <br /> OppoMunGy Commission, Fair EmploymeM and Housing Commission, or any ofher entity. <br /> N. EMPLOYEE JURY SERVICE (ched� one or more boxes) <br /> Contradors wltl� atg�el or amended contracts in excess of 5100,000 must have end edhere fo a wrAten policy thaf <br /> p�oNdes �s empkyees 6ving in San Mateo ComMy up to Rve days regular pay for actual prry service in 1tre Counry. <br /> ✓CoMractor complies with tlie Countys Empbyee Jury Service Orda�ance. <br /> Contrador does not compty wifh the CouMys Employee Jury Service Ordinance. <br /> Co�ac�r � exempt from this requirerr�nt beceuse: <br /> U�e crontract is for $700,000 or less. <br /> ConCaclor fs e perty fo a collective bargaining egreement ihat began on _(date) and expires on _(da�), <br /> and in�nds to compty when the colleclive bargaining agreement e�qrires. <br /> I deelare under penalty of perjury under the laws of the State of Califomla that the forepoing is true and cortect, <br /> and fhat 1 am author'ved to bind this entity contractually. <br /> Sgn �� /.s �c�� Name '/ . � ( <br /> C f v � 1 Ct -� U,i� �( r� "1 <br /> Date T� � <br /> ,� /� <br /> Attest: � �� <br /> Silvia Von erii en, City Clerk <br />