_F_EEO_Contractor_Report_Form_General_Construction.pdf
PDF 82 KB Posted
- Solicitation number
- 2026-RFP-00066
- Issued by
- San Mateo County, California
About this file
This is a Contractor's Declaration Form for a Job Order Contract (JOC) for General Construction at various County of San Mateo owned facilities, covering Project Numbers JOC 2601, JOC 2602, JOC 2603, JOC 2604, and JOC 2605. The form requires contractors to provide detailed information about their compliance with the county's Equal Benefits Ordinance, non-discrimination policies, and Employee Jury Service Ordinance for contracts exceeding specific monetary thresholds.
The document mandates that contractors with contracts over $5,000 must treat spouses and domestic partners equally regarding employee benefits, and those with contracts over $100,000 must have a written policy providing up to five days of regular pay for employees serving jury duty in San Mateo County. Contractors must declare their compliance status by checking appropriate boxes, including whether they offer equal benefits, provide cash equivalents, or are exempt from these requirements. They must also disclose any discrimination findings and their stance on employee jury service, with the entire declaration made under penalty of perjury.
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CONTRACTOR’S DECLARATION FORM
THIS FORM MUST BE COMPLETED IN FULL AND SUBMITTED WITH THE BID
Project: Job Order Contract for General Construction at various County of San Mateo owned facilities for Project No. JOC 2601, JOC 2602, JOC 2603, JOC 2604 and JOC 2605
I CONTRACTOR INFORMATION
Contractor Name: Phone:
Contact Person: Fax:
II EQUAL BENEFITS (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 County’s Equal 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 party 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 box)
Finding(s) of discrimination have been issued against the Contractor within the past year by the Equal 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) 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 the County’s Employee Jury Service Ordinance.
Contractor is exempt from this requirement because:
the contract is for $100,000 or less.
Contractor is a party to a collective bargaining agreement that began on (date) and expires on (date), and intends to comply when said agreement expires.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that I am authorized to bind this entity contractually.
Signature Name
Date Title
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