HomeMy WebLinkAboutattachmentMPREVIOUS CONTRACT NO. H-5-01-090-B1 BID NO. H-9.03.242-191
ATTACHMENT "M"
CERTIFICATION OF VENDORS PROVIDING
BENEFITS FOR DOMESTIC PARTNERS
The undersigned vendor hereby certifies that its employee benefits policies are in compliance with Broward County Ordinance #1999-
03, as amended by Broward County Ordinance #1999-18, as follows:
A. Vendor's employee benefits program includes the following minimum standards:
1. Any vendor's employee who is a party to a domestic partnership relationship is entitled to elect insurance coverage
for his or her domestic partner or a dependent of such domestic partner on the same basis in which any other
vendor's employee may elect insurance coverage for his or her spouse or dependents. A vendor's employee's right
to elect insurance coverage for his or her domestic partner, or the partners dependent, extends to all forms of
insurance provided by the vendor to the spouses and dependents of vendor's employees.
2. Any vendor's employee who is a party to a domestic partnership relationship is entitled to use all forms of Leave
provided by the vendor including, but not limited to sick leave and annual leave to care for his or her domestic partner
or the dependent of the domestic partner as applicable.
3. All other benefits available to the spouses and dependents of vendors employees are made available.on the same
basis to the domestic partner, or dependent of such domestic partner, of a vendors employee who is party to a
domestic partnership relationship.
4. It is within the vendors discretion as to what benefits are provided to Its employees and whether vendors employees
who are party to a domestic partnership relationship must be registered in accordance with Broward County
Ordinance No. 1999-03, as amended, in order to be eligible for access to employee benefits.
B. The vendor's domestic partnership eligibility criteria are substantially equivalent to the following:
1. Each domestic partner is at least 18 years old and competent to contract.
2. Neither domestic partner is married nor a partner to another domestic partnership relationship.
3. The domestic partners are not related by blood.
4. Consent of either domestic partner to the domestic partnership relationship has not been obtained by force, duress, or
fraud. .
5. Each domestic partner agrees to be jointly responsible for eachand shelter. - .
(Vendor signature)
DANIEL D. WEEKLEY, PRESIDENT
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this day of
by
of
(Print vendor name)
as
(Name of person whose signature is being notarized) (Title)
known to me to be the person described
herein, or who produced
NOTARY PUBLIC:
(Name of Corporation/Entity)
(Type of Identification)
(Signature)
(Print name)
State of at Large (SEAL)
My commission expires:
as identification, and who did/did not take an oath.
RMIRS-P809-2003
rt 901/n1
Pogo 94 of 95