Rev. 10/2015 dm Page 3 of 3
Schedule P – (Nuclear Free Zone - Ordinance 11474 C.M.S.)
I declare under penalty of perjury that I have read Ordinance 11478 C.M.S. titled “An Ordinance Declaring the City of Oakland a Nuclear Free
Zone and Regulating Nuclear Weapons Work and City Contracts with and Investment in Nuclear Weapons Makers”, as provided on the City’s
website, see “footnote” below I certify that my firm conforms with the conditions as defined in Ordinance 11478 C.M.S.
I declare that my company is NOT in compliance with Ordinance 11478 C.M.S., but my proposal/bid should be considered because:
Schedule V – (Affidavit of Non-Disciplinary or Investigatory Action)
I certify that the following entities: Equal Employment Opportunity Commission (EEOC), Department of Fair Employment &
Housing (DFEH) or the Office of Federal Contract Compliance Programs (OFCCP) has not taken disciplinary or investigatory action
against the Firm. If such action has been taken, attached hereto is a detailed explanation of the reason for such action, the party
instituting such action and the status or outcome of such action. Initial:
Oakland’s Minimum Wage Law – (Resolution 85423 C.M.S. - Oakland Municipal Code Section 5.92, et seq.) I certify that I have read
Oakland’s minimum wage law and I am in full compliance with all its provisions. Initial:
Affirmative Action - I certify that I/we shall not discriminate against any employee or applicant for employment because of race, color, creed, sex,
sexual orientation, national origin, age, disability, Acquired Immune Deficiency Syndrome (AIDS) AIDS related complex, or any other arbitrary
basis and shall insure compliance with all provisions of Executive Order No. 11246 (as amended by Executive Order No. 11375). I certify that I/we
shall not discriminate against any employee or applicant for employment because they are disabled veteran of the Vietnam era and shall insure
compliance with all provisions of 41CFR60-250.4 where applicable. Initial:
By signing and submitting this combined schedules form the prospective primary participant’s authorized representative
hereby obligates the proposer(s) to the stated conditions referenced in this document. I declare under penalty of perjury that
the foregoing is true and correct.
Name of Individual: Title:
Signature: Date:
PLEASE NOTE: Detailed descriptions of all policies represented in this combined form may be found at Contracts and Compliance website “Policies and
Legislation” address http://www2.oaklandnet.com/Government/o/CityAdministration/d/CP/s/policies/index.htm For an electronic copy of this combined
form and copies of standalone contract Schedules R, E, O, Q, Exit Affidavit and Schedule G please go to this web address
http://www2.oaklandnet.com/Government/o/CityAdministration/d/CP/s/FormsSchedules/index.htm