Form STD.19 "Nondiscrimination Compliance Statement" - California

What Is Form STD.19?

This is a legal form that was released by the California Department of General Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the California Department of General Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form STD.19 by clicking the link below or browse more documents and templates provided by the California Department of General Services.

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Download Form STD.19 "Nondiscrimination Compliance Statement" - California

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STATE OF CALIFORNIA
NONDISCRIMINATION COMPLIANCE STATEMENT
STD. 19 (Rev. 10/2019)
COMPANY NAME
The company named above (herinafter referred to as "prospective contractor") hereby certifies, unless
specifically exempted, compliance with Government Code Section 12990 (a-f) and California Code of
Regulations, Title 2, Division 4, Chapter 5 in matters relating to reporting requirements and the
development, implementation and maintenance of a Nondiscrimination Program. Prospective contractor
agrees not to unlawfully discriminate, harass or allow harassment against any employee or applicant for
employment because of sex, race, color, ancestry, religious creed, national origin, physical disability
(including HIV and AIDS), medical condition (cancer), age (over 40), marital status, denial of family
care leave and denial of pregnancy disability leave.
CERTIFICATION
I, the official named below, hereby swear that I am duly authorized to legally bind the prospective
contractor to the above described certification. I am fully aware that this certification, executed on the
date and in the county below, is made under penalty of perjury under the laws of the State of
California.
OFFICIAL'S NAME
DATE EXECUTED
EXECUTED IN THE COUNTY OF
PROSPECTIVE CONTRACTOR'S SIGNATURE
PROSPECTIVE CONTRACTOR'S TITLE
PROSPECTIVE CONTRACTOR'S LEGAL BUSINESS NAME
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STATE OF CALIFORNIA
NONDISCRIMINATION COMPLIANCE STATEMENT
STD. 19 (Rev. 10/2019)
COMPANY NAME
The company named above (herinafter referred to as "prospective contractor") hereby certifies, unless
specifically exempted, compliance with Government Code Section 12990 (a-f) and California Code of
Regulations, Title 2, Division 4, Chapter 5 in matters relating to reporting requirements and the
development, implementation and maintenance of a Nondiscrimination Program. Prospective contractor
agrees not to unlawfully discriminate, harass or allow harassment against any employee or applicant for
employment because of sex, race, color, ancestry, religious creed, national origin, physical disability
(including HIV and AIDS), medical condition (cancer), age (over 40), marital status, denial of family
care leave and denial of pregnancy disability leave.
CERTIFICATION
I, the official named below, hereby swear that I am duly authorized to legally bind the prospective
contractor to the above described certification. I am fully aware that this certification, executed on the
date and in the county below, is made under penalty of perjury under the laws of the State of
California.
OFFICIAL'S NAME
DATE EXECUTED
EXECUTED IN THE COUNTY OF
PROSPECTIVE CONTRACTOR'S SIGNATURE
PROSPECTIVE CONTRACTOR'S TITLE
PROSPECTIVE CONTRACTOR'S LEGAL BUSINESS NAME