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Caunty of San Mateo <br /> Contractor's Declaration Form <br /> 1. CONTRACTOR INFORMATION <br /> Contractor Name: C of Redw�ood G' Phone: 650-780-7301 <br /> Contact Person: Robert B.Be� Pax: 650-780-7225 <br /> 11ddr+ess: 1017 N�id�efield Road Emaii: b <br /> Redwood City,CA 94�3 Number of em�cY�� soo <br /> IL EQUAL BEMEFITS(check one or more boxes) <br /> Contractors with oo►►t►ads in encess of$5,000 must breat spouses and�mestic partners eq�►y as to emp►oyee benefits. <br /> FT Contractor�mplies with the CouMy's Equal Benefrts Ordinance by: <br /> rJ offering equal benefits�empbyees with spouse,s and empbyees with domestic partners. <br /> � offerir�g a cash equiva�nt payment to eGgibie employ�es in 6eu of equal bene�ts. <br /> r Contractor does not comply with the Count�r's Equal Benefits Ordinance. <br /> r' Contractor is exempt from this requi�ment because: <br /> �- CoMracfiar Mas no employees,dces not provide benef�ts to emPbY"e�'SPo�s�or the corrtract�s for a5,000 <br /> or lsss. <br /> r. Contractor is a party bo a cdle�re bargaining agreerner�that beg�on {datie)�d expires on <br /> {date),�d intends to offer equal benefifs when said agreement expires. <br /> III. NON-DISCRIMINATION(check app�opria�e box) <br /> Finding(s)of d�scximinabon have been issued against Conhactor wRh�tl�e past year by the Equaf Employrrient <br /> r' Oppord,mity Cammission,F�r Empbyme�rt and Hous�g Comm�ssion,or Mher investigativ�e entity. Please see <br /> attached sheet of paper explaining the ouh;ome(s)or r�medy for the d'�scrimination. <br /> � No finding of disaiminatlon has been issued in the past year against the Contracta by the Equal Employme�t <br /> Opport�iityy Commission,Fair Empbyment and Housing Commission,or any other entity. <br /> IV. EMPLOYEE JURY SERVICE(check one or mor�e bozesj <br /> Gon�ors w�lr aig'm�or amended contrads in e�r�ess of$100,000 must have m�d adhe�e to a written po�cy that <br /> provides�7s�oyees liv+rrg in San Mateo County up b fiue atays reyut�pay for ar.tir�jury senACe»the Cow►ty. <br /> R Contractor complies with the County's Employee Jury Senrice Ordinance. <br /> r Gorrtractor does not comply with the Count�s Emplayee J�uy Service Orclinarxe. <br /> C Cor�ractor is exempt from this requirement because: <br /> r' the contract is far$100,OU0 or less. <br /> r CoMractor�a p�ty to a cdlective bargaining agneement that began on (date)and expires on <br /> (date),and intends bo comply wftien the cafle�fire bargaining agreement expires. <br /> r Contractor h�no employees. <br /> r" Comractor has no employees who live in San Mateo County. <br /> I declare under penalty of perjury unde►�the laws of the State of Califomta tl�t the foregoing is true and carect, <br /> and that I am authorized to bind this entlty contractually. <br /> Robe�t B.Bell <br /> Signature Name <br /> ���a�3 Citt�t Marraaer <br /> Date Title <br /> Form issued by ca,vocr complfance comm;meAprtt 17,Io13 <br />