Some Positions Have Pay Rates Less. Than Living Wage Rates Check this box if any positions in this agency have any part of their pay ranges at less than the living wage rates. If this box is checked, the following additional form must be completed and returned with your signed contract: Non-Wage Provisions Form (Form 2) All non-profit agencies not exempt from the new living wage ordinance requirements must also provide wage data information for all employees in job classifications paying less than the current living wage standard. A form to collect this information will be electronically distributed to non-profit contractors in January with a March deadline (date to be determined) to complete and return to the County. I certify, under penalty of perjury, that the above information is true and correct to the best of my knowledge. Signature Director Date Efforts to Maintain and Increase Wages for Positions (Check all applicable boxes) Our agency was able to bring all workers up to a living wage in FY . Our agency was not able to increase pay rates for employee positions in the FY 2003-04 budget. Pay rates for positions in this agency were not reduced in the budget for FY 2003-04. Our agency was able to give our employees the following pay increases (fill in blanks): Cost of Living Adjustment (COLA) increases of % Step or annual increases of or Our agency was able to increase employer-sponsoredbenefits (Check appropriate boxes): Health insurance benefits Paid sick leave benefits Unpaid sick leave benefits Other 0442 FY Living Wage Ordinance Non-Wage Provisions Self-Certification Form County Dept: Contract No: LW Form 2 County of Santa Xxxx won-Profit Agency Attachment] All nonprofit agencies receiving County unless exempt the ordinance requirements, shall comply with the following non-wage provisions of the Living Wage Ordinance (Chapter 2.122 of the County Code):
