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STATE OFCAL IFORNIAp� p� <br />NONDISCRIMINATION COMPLIANCE STATEMENT <br />STD. 19 (REV. 2-93) <br />1] <br />-- ------ -- <br />COMPANY NAME <br />5erulces &U1,rov 'CJO-) He -JA <br />C��d�s;vr <br />The company named above (hereinafter referred to as "prospective contractor") hereby certifies, unless <br />specifically exempted, compliance with Government Code Section 12990 (a -f) and California Code of <br />Regulations, Title 2, Division 4, Chapter 5 in matters relating to reporting requirements and the <br />development, implementation and maintenance of a Nondiscrimination Program. Prospective contractor <br />agrees not to unlawfully discriminate, harass or allow harassment against any employee or applicant for <br />employment because of sex, race, color, ancestry, religious creed, national origin, physical disability <br />(including HIV and AIDS), mental disability, medical condition (cancer), age (over 40), marital status, <br />and denial of family care leave. <br />CERTIFICATION <br />1, the official named below, hereby swear that I am duly authorized to legally bind the prospective <br />contractor to the above described certification. I am fully aware that this certification, executed on the <br />date and in the county below, is made under penalty of perjury under the laws of the State of California. <br />OFFICIAL'S NAME /j <br />DATE EXECUTED EXECUTED IN THE COUNTY OF <br />Ste <br />_ Sort_ _ u u n Co � 1 <br />PROSPECTIVE CON TOR'S SIGNATOR <br />PROS I CONTRACTOR'S TITLG/ <br />fin✓►ron A\V-N i� e o t 14\ a eV -0 , a cvr` 6r <br />IPPOSPECTIVE CONTRACTOR'S LEGAL BUSINESS NAME <br />s �� SO&(A uYh 6tkrdV R--,.0 �1e"l &rv/Ce6 6\11�Onmedo-,J 4eu1Nk ►vls;a)-. <br />