2d.Customer Cert Form for Category 4 - SFGOV-11976_1.pdf
PDF 156 KB Posted
- Solicitation number
- SFGOV-0000011976
- Issued by
- San Francisco County, San Francisco City, California
About this file
This is a Customer Certification Form for a Request for Quotation (RFQ) issued by the City and County of San Francisco's Department of Public Health for the establishment of a prequalified list of vendors to provide as-needed technical assistance and consulting services under Sourcing Event ID SFGOV-00000119796.
The RFQ seeks qualified respondents to provide public health and/or health care program and operations implementation and project management services, including planning, organizing, and overseeing programs or projects to achieve organizational goals within set timeframes and budgets. Category 4 of this procurement specifically targets vendors with demonstrated experience serving public health and/or health care organizations. Respondents must submit customer certification forms completed and signed by representatives of previous customers or clients who can verify the vendor's successful delivery of relevant services. The City will attempt to contact customer references up to three times to verify the information provided. Any proposer submitting invalid customer contact information or whose customer references are unreachable may be deemed non-responsive. The form requires customers to provide their name, location, and contact information (name, title, phone number, and email address of the certifying representative), along with a signature and date to authenticate the reference.
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Text version
SOURCING EVENT ID: SFGOV-00000119796
RFQ FOR THE ESTABLISHMENT OF A PREQUALIFIED LIST
FOR AS-NEEDED TECHNICAL ASSISTANCE AND CONSULTING SERVICES
FOR THE DEPARTMENT OF PUBLIC HEALTH
I f 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 w ill only attempt to contact the listed customer contact three (3) t imes. The City reserves the right to deem non-responsive any Proposer who submits invalid customer contact, or if the customer contact is unreachable.
Customer Certification Form for Category 4: Public Health and/or Health Care Program and Operations Implementation and Project Management Services
(To be Signed by Responder’s Customer)
SFGOV-0000011976 As-Needed Technical Assistance and Consulting Services
Responder has successfully provided public health or health care program and operations implementation or project management, including planning, organizing, and overseeing programs or projects to achieve goals within a set time and budget for a public health and/or health care organization.
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: |
| Phone Number same person identified in 3 above: |
| Email same person identified in 3 above: |
| Name and Title: |
File details come from the government source that posted it. Updated .