Agmt13 County of San Mateo- Fair Oaks Community Center

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Exhibit C County of San Mateo Contractor's Declaration Form I. CONTRACTOR INFORMATION Contractor Name: City of Redwood City—Fair Oaks Phone: (650)780-7500 Communit Center Contact Person: Teri Chin, Human Services Mana er Fax: 650 298-8184 Address: 2600 Middlefield Road Number of employees: Redwood City,CA 94063 II. EQUAL BENEFITS(check one or more boxes) Contractors with contracts in excess of$5,000 must treat spouses and domesfic partners equaNy as to employee benefifs. :I� Contractor complies with the County's Equal Benefits Ordinance by: ;s� offering equal benefits to employees with spouses and employees with domestic partners, i�" 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, tloes not provitle benefits to empioyees'spouses,or the contract is for$5,000 orless. �� Contractor is a party to a coilective 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 box) Finding(s)of tliscrimination have been issued against Contractor within the past year by the Equai �.. Employment Opportunity Commission, Fair Employment and Housing 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(check one or more boxes) Confractors 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 the County's Empioyee Jury Service Ordinance. �`� Contractor is exempt from this requirement because: r the contract is for$100,000 or less. ATTY/AGR/2013.OSS/FAIR OAKS COMMUNITY CENTER REV:04-15-13 MLG Page 14 of 17