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<br />PREVIOUS CONTRACT NO. N/A <br /> <br />BID NO. Q-9-08-279-FF <br /> <br />ATTACHMENT "0" <br />CERTIFICATION OF VENDORS PROVIDING <br />BENEFITS FOR DOMESTIC PARTNERS <br />The undersigned vendor hereby certifies that its employee benefits policies are in compliance with Broward County Ordinance #1999-03, as <br />amended by Broward County Ordinance #1999-18, as follows: <br /> <br />A. Vendor's employee benefits program includes the following minimum standards: <br /> <br />1. Any vendor's employee who is a party to a domestic partnership relationship is entitled to elect insurance coverage for his <br />or her domestic partner or a dependent of such domestic partner on the same basis in which any other vendor's employee <br />may elect insurance coverage for his or her spouse or dependents. A vendor's employee's right to elect insurance <br />coverage for his or her domestic partner, or the partner's dependent, extends to all fonns of insurance provided by the <br />vendor to the spouses and dependents of vendor's employees. <br /> <br />2. Any vendor's employee who is a party to a domestic partnership relationship is entitled to use all forms of leave provided <br />by the vendor including, but not limited to sick leave and annual leave to care for his or her domestic partner or the <br />dependent of the domestic partner as applicable. <br /> <br />3. All other benefits available to the spouses and dependents of vendor's employees are made available on the same basis <br />to the domestic partner, or dependent of such domestic partner, of a vendor's employee who is party to a domestic <br />partnership relationship. <br /> <br />4. It is within the vendor's discretion as to what benefits are provided to its employees and whether vendor's employees who <br />are party to a domestic partnership relationship must be registered in accordance with Broward County Ordinance No. <br />1999-03, as amended, in order to be eligible for access to employee benefits. <br /> <br />B. The vendor's domestic partnership eligibility criteria are substantially equivalent to the following: <br /> <br />1. <br />2. <br />3. <br />4. <br />5. <br /> <br />Each domestic partner is at least 18 years old and competent to contract. <br />Neither domestic partner is married nor a partner to another domestic partnership relationship. <br />The domestic partners are not related by blood. <br />Consent of either domestic partner to the domestic partnership relationship has not been obtained by force, duress, or <br />fraud. <br />Each domestic partner agrees to be jointly responsible for each other's basic food and shelter. <br /> <br />~~ <br />'SUV\ '5hao~ \ Me... / C.hri<::> facob5 <br />(Prin vendor rfame) . <br /> <br />STATE OF ]O\\dC\. <br />COUNTY OF '?YfO\}JOl ~ <br /> <br /> <br />The for oing instrument was acknowledged before me this ..30..- day of <br />by , <br />of Su V\ '5~~~~ ~~on whose signature is being notarized) <br /> <br />.. \ (!'lcl'1)8 0, f COrPoration/entity) <br />herein, or who produced ~~ f112i.... <br />('1\Ype of identification) <br /> <br />~ <br /> <br />OOtobe,{' <br /> <br />as <br /> <br />, JooB <br /> <br />(Title) <br />, known to me to be the person described <br /> <br />as identification, and who did/did not take an oath. <br /> <br />at Large (SEAL) <br /> <br />My commission expires: <br /> <br />~~"It~ PATRICIA B HARRINGTON <br />~ MY COMMISSION /I 00S21041 <br />.,. ~ <br />.,"orr....~ EXPIRES: Feb. 21, 21)\1) <br />(407) 398.0153 f-lorId. NoIery s.ntce.com <br /> <br />PSS-PB09-2008 <br />10/14/08 <br /> <br />Page 33 of 34 <br />