(RFP) - Terminal Operator Services for the Statewide Fingerprint ...

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RFP Appendix D, Exhibit 18 Page 2 of 3 COUNTY OF LOS ANGELES LIVING WAGE PROGRAM APPLICATION FOR EXEMPTION My business is subject to a bona fide Collective Bargaining Contract(attach Contract); AND the Collective Bargaining Contract expressly provides that it supersedes all of the provisions of the Living Wage Program; OR the Collective Bargaining Contract expressly provides that it supersedes the following specific provisions of the Living Wage Program (I will comply with all provisions of the Living Wage Program not expressly superseded by my business’ Collective Bargaining Contract): ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ I declare under penalty of perjury under the laws of the State of California that the information herein is true and correct. PRINT NAME: TITLE: SIGNATURE: DATE: REVIEWED BY COUNTY: SIGNATURE OF REVIEWER APPROVED DISAPPROVED DATE 192
RFP Appendix D, Exhibit 18 Page 3 of 3 COUNTY OF LOS ANGELES LIVING WAGE PROGRAM APPLICATION FOR EXEMPTION Additional Information The additional information requested below is for information purposes only. It is not required for consideration of this Application for Exemption. Thee County will not consider or evaluate the information providedd below by Contractor, in any way whatsoever, when recommending selection or award of a Contract to the Board of Supervisors. I, or my collective bargaining unit, have a bona fide health care benefit plan for those employees who will be providing services to the County under the Contract. Health Plan Company Name(s): __________ _____________________________________ Company Insurance Group Number(s):______ __________ ____________________________ Health Premiumm Amount Paid by Employer:_______ __________ __________ ______________ Health Premiumm Amount Paid by Employee:_______ _______________________________ Health Benefit(s) Payment Schedule: (Specify) Monthly Quarterly Annually Other: ________________________________________ Bi-Annual I, or my collective bargaining unit, do not havee a bona fide health care benefit plan for those employees who will be providing services too the County under the Contract. 193
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DEPARTMENT OF PUBLIC SOCIAL SERVICE
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REQUEST FOR PROPOSALS STATEWIDE FIN
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RFP APPENDIX A, SAMPLE CONTRACT STA
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RFP APPENDIX B, STATEMENT OF WORK (
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RFP, APPENDIX C [CONTRACT, ATTACHME
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SOW Exhibit B-2 RFP, APPENDIX C [CO
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RFP Appendix C, RFP, APPENDIX C SOW
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RFP Appendix C, RFP, APPENDIX C SOW
Page 141 and 142: RFP, APPENDIX C [CONTRACT, ATTACHME
Page 171 and 172: EXHIBITS APPENDIX D REQUIRED FORMS
Page 173 and 174: APPENDIX D REQUIRED FORMS RFP Appen
Page 175 and 176: APPENDIX D REQUIRED FORMS STATEWIDE
Page 177 and 178: STATEWIDE FINGERPRINT IMAGING SYSTE
Page 179 and 180: RFP Appendix D, Exhibit 7-A Use thi
Page 181 and 182: RFP Appendix D, Exhibit 8 STATEWIDE
Page 183 and 184: RFP Appendix D, Exhibit 10 STATEWID
Page 185 and 186: RFP Appendix D, Exhibit 12 STATEWID
Page 187 and 188: RFP Appendix D, Exhibit 14 Medical
Page 189 and 190: RFP Appendix D, Exhibit 16 COUNTY O
Page 191: RFP Appendix D, Exhibit 18 Page 1 o
Page 195 and 196: RFP Appendix D, Exhibit 20 TRANSITI
Page 197 and 198: APPENDIX E TRANSMITTAL FORM TO REQU
Page 199 and 200: APPENDIX G - 1 NOTICE OF INTENT TO
Page 201 and 202: APPENDIX H Vendor Name: Solicitatio
Page 203 and 204: APPENDIX J LISTING OF CONTRACTORS D
Page 205 and 206: APPENDIX K Page 2 of 5 Title 2 ADMI
Page 207 and 208: Title 2 ADMINISTRATION DETERMINATIO
Page 209 and 210: 209 APPENDIX L
Page 211 and 212: APPENDIX N Page 1 of 2 BACKGROUND A
Page 213 and 214: APPENDIX O Page 1 of 3 Title 2 ADMI
Page 215: APPENDIX O Page 3 of 3 Title 2 ADMI
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