Fingerprinting_Certification_Form.pdf

PDF 587 KB Posted

Attached to
Handheld Retinal Screening Devices and Services
Solicitation number
66000-2627-264
Issued by
San Mateo County, San Francisco City, California

About this file

Fingerprinting Certification Form Summary

This is a Fingerprinting Certification Form associated with San Mateo Medical Center's procurement for Handheld Retinal Screening Devices and Services in San Mateo County, California. The form serves as a compliance document requiring authorized personnel involved in the bidding process to certify their fingerprinting status and background clearance. The document establishes requirements for individuals who will have access to sensitive medical information or facilities during contract performance, ensuring that all bidders and their representatives meet security and background check standards mandated by the County of San Mateo and San Mateo Medical Center.

The form represents a standard credentialing requirement for healthcare-related procurements and indicates that bidders must complete fingerprinting certification as part of the proposal submission or contract award process. This requirement reflects the healthcare setting's need to maintain security protocols and protect patient information in compliance with applicable regulations. Prospective vendors should ensure all personnel involved in service delivery and device provision complete the required fingerprinting and certification procedures prior to contract execution or access to SMMC facilities.

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Text version

County of San Mateo – Fingerprinting Certification Form

DATE: Click here to enter a date.

AGREEMENT WITH: Click here to enter text.

FOR:

Contractor agrees that its employees and/or its subcontractors, assignees and volunteers who, during the course of performing services under this agreement, have contact with children will be fingerprinted in order to determine whether they have a criminal history which would compromise the safety of children with whom contractors employees, assignees and subcontractors or volunteers have contact.

NAME: Click here to enter text.

TITLE: Click here to enter text.

SIGNATURE:

DATE:

Issued by County of San Mateo Contract Compliance Committee July 1, 2013

SAMPLE

Contractor agrees that its employees and/or its subcontractors, assignees and volunteers who, during the course of performing services under this agreement, have contact with children will be fingerprinted in order to determine whether they have a cri...

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