2c. Customer Certification Form for Category 3.pdf

This is a Customer Certification Form for Category 3 associated with Request for Qualifications (RFQ) SFGOV-0000011970 issued by the San Francisco Department of Public Health (DPH) for As-Needed Community Outreach and Media Services. The form is designed to be completed and signed by customers of responding firms to certify that the responder has successfully provided on-the-ground community outreach services, including tabling at community events, attending community group meetings, and conducting door-to-door flyering. The RFQ seeks qualified firms to provide community outreach and media services for the San Francisco Health Network (SFHN), Behavioral Health Services (BHS), and Population Health Division (PHD), with services intended to serve all San Francisco residents while addressing the unique cultural needs of populations experiencing disparate public health impacts. The submission deadline for responses is September 16, 2026 at 2:00 PM PT, with the estimated announcement of prequalified lists scheduled for October 2, 2026. The prequalified lists will be valid through March 11, 2029. This is a reissue of RFQ 0000010081, and vendors who previously qualified under that solicitation will remain qualified without resubmission, though they may choose to resubmit.

The form requires respondents to provide valid customer contact information for each customer certification, with the City reserving the right to contact the listed customer representative up to three times to verify the services provided. Respondents who fail to submit valid customer contact information or whose customers are unreachable may be deemed non-responsive. The form requests customer name, location, representative name and title, signature, phone number, and email address for verification purposes. No pricing information, set-asides, incumbent contractor details, or funding amounts are specified in this certification form document.