Common use of EMPLOYEE JURY SERVICE Clause in Contracts

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 the collective bargaining 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

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 the collective bargaining 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 NameName Date Title

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 less than $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 the collective bargaining 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 NameName Date Title Exhibit D Additional Program Requirements

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 the collective bargaining 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 NameName Date Title Exhibit E

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 less than $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 the collective bargaining 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 NameSIGNATURE PRINTED NAME

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 the collective bargaining 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 NameName Date Title Exhibit G

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 the collective bargaining 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 NameName _

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 the collective bargaining 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 NameName Date Title 8-7-06 Page 1 of 1 Attachment F

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 the collective bargaining 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. Xxxxx Xxxxx Signature NameName Date Title

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 less than $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 the collective bargaining 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 NameName Date Title 8-7-06 Page 1 of 1 Exhibit E

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 the collective bargaining 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 NameName Date Title EXHIBIT F Child Abuse Prevention and Reporting

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 the collective bargaining 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 NameName Date Title EXHIBIT E

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 less than $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 the collective bargaining 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 NameName Date Title

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 the collective bargaining 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 NameName Date Title EXHIBIT F

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 the collective bargaining 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 NameName Date Title 8-7-06 Page 1 of 1 Attachment D

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 the collective bargaining 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. Xxxx Xxxxxx Signature NameName Executive Director, Health Plan of San Mateo Date Title

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 the collective bargaining 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

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 the collective bargaining 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 NameName Date Title Exhibit F CHILD ABUSE REPORTING REQUIREMENT

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 the collective bargaining 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 NameName Date Title ATTACHMENT Insert Insurance Documents ATTACHMENT

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 the collective bargaining 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. Xxxxx Xxxxxxxx Signature NameName Regional Vice President Date Title