2a.Customer Cert Form for Category 1 - SFGOV-11976_1.pdf

This is a Customer Certification Form for Category 1 of a Request for Quotation (RFQ) issued by the City and County of San Francisco, Department of Public Health, for the establishment of a prequalified list of vendors to provide as-needed technical assistance and consulting services. The RFQ, identified as SFGOV-0000011976, specifically seeks respondents who have successfully applied for and been awarded public health grant funds for public health organizations. Respondents must obtain certification from their customers demonstrating prior experience in this category. The form requires completion and signature by a customer representative and includes fields for customer name, location, and contact information for verification purposes. The City reserves the right to contact customer references up to three times to verify the services indicated and may deem any proposer non-responsive if the customer contact information is invalid or unreachable.

The certification form serves as a qualification requirement for vendors seeking inclusion on the prequalified list and does not specify pricing terms, set-asides, or contract award amounts within the document itself. The form emphasizes verification of past performance in public health grant and research development, suggesting that relevant experience is a primary evaluation criterion. Respondents unable to obtain a signed customer certification form must provide valid contact information allowing the City to independently verify the claimed services and customer relationships.