10838__Exhibit5_ReleaseAffidavit.pdf
PDF 115 KB Posted
- Attached to
- Leon County Juvenile Assessment Center (JAC), Circuit 2 (Leon, Gadsden, Franklin, Wakulla, Jeffers
- Solicitation number
- RFP-07916
- Issued by
- Leon County, Florida
About this file
This document is an Exhibit 5 Release Affidavit for the Leon County Juvenile Assessment Center (JAC) contract opportunity. The Department of Juvenile Justice (DJJ) and the Office of Probation and Community Intervention are issuing this Request for Proposal (RFP) for administrative services, detention screening, intake screening, and security at the JAC located in Leon County, which serves Circuit 2 (Leon, Gadsden, Franklin, Wakulla, Jefferson, and Liberty Counties) and Circuit 3 (Taylor and Madison Counties) in the North Region. The selected Provider shall provide these services 24 hours per day, 7 days a week. All public meetings have been cancelled.
The pricing terms, set asides, incumbent contractor, funding requirements and sources, and other salient details are not provided in this exhibit. However, the Exhibit 5 Release Affidavit requires the parent, guardian, or responsible adult of the child being assessed to provide personal information and attest that the information is true and factual.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| RFP10838_Final.pdf | ||
| RFP10838_N_IntenttoSubmit.pdf | ||
| RFP10838_Q_ProposalVerification.pdf | ||
| RFP10838_S_TieBreakingCertifications.pdf | ||
| 10838_H_Budget.xlsx | XLSX spreadsheet | |
| RFP10838_RejectAll_AgencyDecision.pdf | ||
| RFP10838_L_ForeignCountry.pdf | ||
| 10838_Exhibit_4_Clearance Form.pdf |
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Text version
EXHIBIT 5
Department of Juvenile Justice Juvenile Assessment Center
Parent/Responsible Adult Release Affidavit
I, ____________________________________________________ Name attest that I am the _____________________________________of Parent/Guardian/Responsible Adult
________________________________________ whose address is Child’s Name
__________________________________________________, and Address date of birth is ________________________. I may be reached at
DOB
Home Phone Cellular Phone and/ or _________________________.
Pager
Parents Information
Date of Birth ___________________________
Type of Identification provided: ______________________________
I attest that the above information is true and factual.
Signature of Parent/Guardian/Responsible Adult Date
Witness
Reviewed By:
Intake Screener Date
Lead Screener Date
File details come from the government source that posted it. Updated .