2b. Customer Certification Form for Category 2.pdf
PDF 202 KB Posted
- Solicitation number
- SFGOV-0000011970
- Issued by
- San Francisco County, California
About this file
This is a Customer Certification Form for Category 2 associated with an As-Needed Community Outreach and Media Services Request for Qualifications (RFQ 0000011970) issued by the City and County of San Francisco's Department of Public Health (DPH). The form is designed to verify that respondents have successfully provided print and other promotional materials, including the creation and distribution of posters, advertisements, and signage. The RFQ was published on August 10, 2026, with a deadline for submitting questions by 5:00 PM PT on August 27, 2026, and a Q&A addendum estimated to be posted on September 4, 2026. Responses are due by 2:00 PM PT on September 16, 2026, with an estimated announcement of the Prequalified List(s) on October 2, 2026. The prequalified lists will expire on March 11, 2029. This RFQ reopens the unranked Prequalified Lists originally established on March 11, 2025, under RFQ 0000010081, and vendors previously qualified under that earlier RFQ will retain their qualified status without needing to resubmit.
The Community Outreach and Media Services are intended to serve all San Francisco residents who qualify, with focused expertise to address the unique cultural needs of residents experiencing disparate impacts from public health issues, including those served by the San Francisco Health Network, Behavioral Health Services, and Population Health Division. The Customer Certification Form requires respondents to provide customer contact information for verification purposes, including the customer name, location, representative name and title, signature, phone number, and email address. The City reserves the right to deem non-responsive any responder who submits invalid customer contact information or if the customer contact is unreachable after three (3) attempted contacts.
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Text version
SOURCING EVENT ID: SFGOV-0000011970
AS-NEEDED COMMUNITY OUTREACH AND MEDIA SERVICES
FOR THE DEPARTMENT OF PUBLIC HEALTH
If a customer is unable to sign a customer certification form, the respondent must include valid contact information for The City to contact and verify services indicated above. The City wil l only attempt to contact the l isted customer contact three (3) times. The City reserves the right to deem non-responsive any Responder who submits invalid customer contact, or if the customer contact is unreachable.
Customer Certification Form for Category 2: Print and other promotional material (To be Signed by Responder’s Customer)
SFGOV-0000011970 As-Needed Community Outreach and Media Services
Responder has successfully provided print and other promotional material. This includes but is not limited to creating and distributing posters, advertisements, and signage.
Customer #1
1. Customer Name:
2. Customer Location:
3. Name and title of Customer representative completing this form:
Signature (same person identified in #3 above):
Date:
Phone Number (same person identified in #3 above):
Email (same person identified in #3 above):
| 1 Customer Name: |
| 2 Customer Location: |
| undefined: |
| Date: |
| Phone Number same person identified in 3 above: |
| Email same person identified in 3 above: |
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