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<br />EXHIBIT C <br />COUNTY OF SAN MATEO <br /> <br />Equal Benefits Compliance Declaration Form <br /> <br /> <br />I Vendor Identification <br /> <br />Name of Contractor: City of Redwood City <br />Contact Person: Rn.hd,d Eldi", Jp ~ :t:=ro-.. <br />Address: 1017 Middlefield Road <br />Redwood City,CA 94063 <br />Phone Number: (650)780-7000 <br />Fax Number: <br /> <br /> <br />II Employees <br />Does the Contractor have any employees? ø Yes 0 No <br />Does the Contractor provide benefits to spouses of employees? ' ZI Yes 0 No <br />"If the answer to one or both of the above is no, please skip to Section IV." <br /> <br /> <br />III Eaual Benefits Compliance (Check one) <br /> <br />I:¡i Yes, the Contractor complies by offering equal benefits, as defined by Chapter 2,93, to its <br />employees with spouses and its employees with domestic partners. <br />0 Yes, the Contractor complies by offering a cash equivalent payment to eligible employees <br />in lieu of equal benefits, <br />0 No, the Contractor does not comply. <br />0 The Contractor is under a collective bargaining agreement which began on <br /> <br />(date) , and expires on (date). <br /> <br /> <br />IV Declaration <br /> <br />I declare under pen¡¡>'ty of perjury under the laws of the State of California that the foregoing is true and <br />:p¡ßrrect and t.hat I am autho.rized to bind this entity contractually, <br /> <br />L~ ¡'~. <br />, g at e 1~ me (Please Print) <br /> <br />_//~~{ ~-1-¿- /5- 03 <br />it Date <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Page 160f25 <br />