2e. Customer Certification Form for Category 5.pdf
PDF 201 KB Posted
- Solicitation number
- SFGOV-0000011970
- Issued by
- San Francisco County, California
About this file
This is a Customer Certification Form for Category 5 (Focus Groups) related to an As-Needed Community Outreach and Media Services Request for Qualifications (RFQ 0000011970) issued by the City and County of San Francisco Department of Public Health (DPH). The solicitation seeks qualified firms to provide community outreach and media services to the San Francisco Health Network, Behavioral Health Services, and Population Health Division, with services targeted to serve all San Francisco residents with focused expertise in meeting the cultural needs of residents experiencing disparate impacts from public health issues. The RFQ represents a reissue of RFQ 0000010081 to re-open unranked Prequalified Lists. Key dates include an RFQ publication date of August 10, 2026, a deadline for questions by 5:00 PM PT on August 27, 2026, an estimated Q&A addendum posting on September 4, 2026, and a response submission deadline of 2:00 PM PT on September 16, 2026. The estimated announcement of Prequalified Lists is October 2, 2026, with the re-opened lists set to expire on March 11, 2029. Responders who previously qualified under RFQ 0000010081 retain their qualification status and are not required to resubmit unless they choose to do so.
The Customer Certification Form requires respondents to provide evidence of successfully facilitating focus groups with community stakeholders and conducting assessments to develop effective, culturally appropriate messaging for marketing materials and campaigns. The form requires customer references to be signed by the actual customer representative, including their name, title, location, phone number, email, and date. If a customer is unable to sign the certification form, the respondent must provide valid contact information for the City to verify the services described. The City reserves the right to deem a respondent non-responsive if invalid customer contact information is submitted or if the customer contact is unreachable after three (3) contact attempts.
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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 5: Focus groups (To be Signed by Responder’s Customer)
SFGOV-0000011970 As-Needed Community Outreach and Media Services
Responder has successfully facilitated focus groups with community stakeholders and conducted assessments to develop effective, culturally appropriate messaging for marketing material and campaigns.
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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