Fingerprinting_Certification_Form.pdf

This is a Fingerprinting Certification Form issued by the County of San Mateo Contract Compliance Committee effective July 1, 2013. The form applies to contractors and their employees, subcontractors, assignees, and volunteers performing services under county agreements that involve contact with children. The form requires that all personnel with child contact undergo fingerprinting to determine criminal history and assess potential safety risks. The certification must be completed and signed by an authorized representative of the contracting entity, with spaces provided for the contractor name, signatory title, signature, and date of execution.

The fingerprinting requirement applies directly to the Human-centered Designer Onsite Support contract with San Mateo Medical Center, which involves work with the Health Futures Lab's youth behavioral health co-design initiative. This compliance measure ensures that all contractor personnel meeting with or providing services to children have undergone criminal background screening as a condition of contract performance. The form serves as documentation that the contractor has acknowledged and will comply with this mandatory safety requirement prior to commencing work under the county agreement.