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6.1.E. - Page 16 <br /> Exhibit C <br /> County of San Mateo <br /> Contractor's Declaration Form <br /> I. CONTRACTOR INFORMATION <br /> Contractor Name: City of Redwood City—Fair Oaks Phone: (650)780-7500 <br /> Communit Center <br /> Contact Person: Teri Chin, Human Services Mana er Fax: 650 298-8184 <br /> Address: 2600 Middlefield Road Number of employees: <br /> Redwood City, CA 94063 <br /> II. EQUAL BENEFITS(check one or more boxes) <br /> Contractors with contracts in excess of$5,000 must treat spouses and domestic partners equally as to <br /> employee benefits. <br /> � Contractor complies with the County's Equal Benefits Ordinance by: <br /> � offering equal benefits to employees with spouses and employees with domestic partners. <br /> � offering a cash equivalent payment to eligible employees in lieu of equal benefits. <br /> � Contractor does not comply with the County's Equal Benefits Ordinance. <br /> � Contractor is exempt from this requirement because: <br /> � Contractor has no employees, does not provide benefits to employees' spouses, or the contract is for$5,000 <br /> or less. <br /> � Contractor is a party to a collective bargaining agreement that began on (date)and expires on <br /> (date), and intends to offer equal benefits when said agreement expires. <br /> III. NON-DISCRIMINATION(check appropriate box) <br /> Finding(s)of discrimination have been issued against Contractor within the past year by the Equal <br /> � Employment Opportunity Commission, Fair Employment and Housing Commission, or other <br /> investigative entity. Please see attached sheet of paper explaining the outcome(s)or remedy for <br /> the discrimination. <br /> No finding of discrimination has been issued in the past year against the Contractor by the Equal <br /> � Employment Opportunity Commission, Fair Employment and Housing Commission,or any other <br /> entity. <br /> IV. EMPLOYEE JURY SERVICE (check one or more boxes) <br /> Contractors with original or amended contracts in excess of$100,000 must ha ve and adhere to a written <br /> policy that provides its employees living in San Mateo County up to fi"ve days regular pay for actual�ury <br /> service in the County. <br /> � Contractor complies with the County's Employee Jury Service Ordinance. <br /> � Contractor does not comply with the County's Employee Jury Service Ordinance. <br /> � Contractor is exempt from this requirement because: <br /> � the contract is for$100,000 or less. <br /> ATTY/AGR/2013.055/FAIR OAKS COMMUNITY CENTER <br /> REV:04-15-13 MLG <br /> Page 14 of 17 <br />