1412207679 PRA Evaluation Form Contractor.pdf
PDF 481 KB Posted
- Attached to
- Hydrated Ash Hauling and Disposal
- Solicitation number
- 1412207679
- Issued by
- Duval County, Florida
About this file
This is a PRA Contractor Evaluation Form issued by JEA (Jacksonville Electric Authority) in Florida, effective as of November 25, 2015, with the most recent modification dated March 18, 2019. The form is designed to document and verify contractor eligibility and security clearance prior to granting access to JEA's sensitive systems and facilities. The evaluation process requires contractors to complete identity verification using USCIS I-9 acceptable documents, undergo a comprehensive criminal history records check covering a minimum of seven years including all current and past residences where the individual lived for at least six months, and submit a full Federal Court National Criminal Records check covering the same seven-year period. Background checks must be updated every seven years for contractors with ongoing access to sensitive systems and applications. Contractors must provide substantive evidence of their background check, either through a redacted background check or background check receipt from an approved vendor, which JEA must retain for ten years in accordance with Florida General Records Schedule requirements.
The evaluation form requires verification that contractors are not listed on the US Government Watch List, including OFAC and FBI Terrorist Watch List designations, and any criminal convictions identified must be documented and reviewed. The form includes sections for JEA contact information, contractor details, and signature blocks for both the attesting party and JEA reviewers. The Chief of Department signature is required only if an exception is made to standard requirements, while the Final Reviewer signature is mandatory for all evaluations. Proper data redaction procedures must be followed to ensure that redacted information is non-recoverable while maintaining sufficient documentation to verify the background check's authenticity, date of conduct, and scope of review. This form serves as the gatekeeper mechanism for contractor access to JEA's critical infrastructure and sensitive applications.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 1412207679 Appendix B - Response Workbook.xlsx | XLSX spreadsheet | |
| 1412207679 Evaluation Matrix.pdf | ||
| 1412207679 Appendix B - Response Forms.pdf | ||
| 1412207679 Appendix A - Technical Specificiations.pdf | ||
| 1412207679 ITN Solicitation.pdf | ||
| 1412207679 Appendix B - List of Subcontractors Form.xlsx | XLSX spreadsheet |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
PRA Contractor Evaluation Form (effective 11/25/15)
Last Modified: March 18, 2019
PRA Contractor Evaluation Form Contractor Background Check Attestation
JEA Contact Name:
JEA Contact Phone No:
JEA Contact E-mail:
In order to ensure the security of JEA’s systems and facilities a background check must be conducted for contractors prior to access being granted to sensitive systems and applications. An updated background check is required every 7 years for contractors with access to these systems. Please complete the below form and send the completed copy with substantive evidence (i.e. redacted background check or background check receipt)1 to recsel@jea.com. The evidence of background check must be retained for 10 years by Contractors2. Any questions can be addressed to your JEA contact.
Date of Evaluation: Date Background Check:
Position: Contractor Full Name:
Begin on JEA Acct: End Date or Ongoing:
Contract Manager: Contract Manager Phone:
Section A – Identity Verification
The identity of the individual must be confirmed. The USCIS I-9 List of Acceptable Documents will be used (one selection from List A, or a combination of one selection from List B and one selection from List C may be used). Means used to verify identify must be listed below.
Identity Verified: Yes or No (circle one)
Method used to verify person’s identity?
Notes: (If no, please explain)
Section B – Criminal History Records Check
The criminal history records check (aka background check) must include a Federal, State, and County criminal records search for a minimum of 7 years, including: current residence regardless of duration, and locations where the individual has resided for at least 6 months. If it is not possible to perform a full seven year criminal history records check, conduct as much of the 7 year criminal records check as possible and document the reason the full seven year criminal history records check could not be performed in the notes section. (CIP 004 R3.2)
Full 7 year criminal records check available (Federal, State, and County): Yes or No (circle one)
Criminal records check performed, including current residence: Yes or No (circle one)
Criminal records check performed, including other locations of residence in past 7 years: Yes or No (circle one)
Method used:
Notes: (If no, please explain)
1 Proper methods of data redaction ensure the redacted data and/or metadata and elements are removed and non-recoverable.
Information remaining on background check and background check receipt must be sufficient enough that the background check can be verified belonging to the individual, date the background check was conducted, and what was included in the background check.
If any criminal flags are identified a redacted background check must be provided. Receipts must come from background screening vendor.
2 JEA must follow Florida General Records Schedule. Refer to Screening Personnel Risk Assessments Procedure Section 7.4 for requirement.
mailto:recsel@jea.com
PRA Contractor Evaluation Form (effective 11/25/15)
Last Modified: March 18, 2019
Section C – Federal Court National Criminal Check
Full 7 year Federal Court Criminal Records check was available: Yes or No (circle one)
Notes: (If no, please explain)
Convictions Identified: Yes or No (circle one)
List All Convictions identified:
Method used:
Section D – Criminal Flags
Note any convictions identified on background check. Also you must verify the contractor is not on the US Government Watch List.
Convictions Identified: Yes or No (circle one)
On US Government Watch List (OFAC, FBI Terrorist Watch List): Yes or No (circle one)
List All Convictions identified:
Notes: (If yes, please explain)
Attesting Party’s Signature:
By signing below I attest the information above is accurate.
Name, Title, & Contact No.:
Company Name:
Signature:
Date Completed:
(Area below to be completed by JEA)
Reviewers’ Signatures:
Chief of Department: (required if exception was made)
Name:
Date Reviewed:
Reason for exception:
Final Reviewer: (always required)
Name & Title:
Date Reviewed:
File details come from the government source that posted it. Updated .