Agmt13 County of San Mateo Dept of Housing - re-turf Fair Oaks Athletic Field

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Exhibit C Contractor's Declaration Form I. CONTRACTOR INFORMATION Contractor City of Redwood City Phone: (650) 780-7200 Name: Contact Person: Chris Beth Fax: Address: 1400 Roosevelt Ave. Redwood City, CA 94061 Ii. EQUAL BENEPITS (check one or more boxes) Contractors with contracts in excess of$5,000 must treat spouses and domestic partners equally as to employee benefits. � Contractor complies with the Covnty's Equcrl Benefits Ordinance by: � offering equal benefits to employees with spouses and employees with domestic partners. ❑ offering a cash equivalent payment to eligible employees in lieu of equal benefits. ❑ Contractor does not comply with the County's Equal Benefits Ordinance. ❑ Contractor is exempt from this requirement because: � Contractor has no employees, does not provide benefits to employees'spouses, or the contract is for$5,000 or less. � Contractor is a parfy to a collective bargaining agreement that began on (date) and expires on (date), and intends to offer equal benefits when said agreement expires. III. NON-DISCRIMINATION (check appropriate boxl Finding(s) of discrimination have been issued against Contractor within the past year by the Equal ❑ Employment Opporfunity Commission, Fair Employment and Housrng Commission, or other investigative entity. Please see attached sheet of paper explaining the outcome(s) or remedy for the discrimination. � No finding of discrimination has been issued in the past year against the Contractor by the Equal Employment Opportunity Commission, Fair Employment and Housing Commission, or any other entity. IV. EMPLOYEE JURY SERVICE fcheck one or more boxes) Contractors with original or amended contracts in excess of$100,000 must have and adhere to a written policy that provides its employees living in San Mateo County up to five days regular pay for actual jury service in the County. � Contractor complies with the County's Employee Jury Service Ordinance. ❑ Contractor does not comply with fihe County's Employee Jury Service Ordinance. ❑ Contractor is exempt from this requirement because: ❑ the contract is for$100,000 or less. Contractor is a parfy to a collective bargaining agreement that began on (dateJ and ❑ expires on (dafe), and intends to comply when the collective bargaining agreement expires. I lare u e penalty of perjury under the laws of the State of California that the foregoing is true and correct, nd that authorized to bind this entity contractually. Signature ' Christopher Beth Director ��5�� Parks, Recreation and Community Services Date Title ATTY/AGR/2013.016/FAIR OAKS SCHOOL RE-TURFING PROJECT II REV:O1-29-13 MLG Page 15 of 21