Fingerprinting_Certification_Form.pdf

PDF 587 KB Posted

Attached to
Teleneurology services
Solicitation number
66600-2526-237
Issued by
San Mateo County, San Francisco City, California

About this file

This is a Fingerprinting Certification Form issued by the County of San Mateo Contract Compliance Committee, dated July 1, 2013, applicable to contractors and service providers engaged with the county. The form establishes a requirement that all employees, subcontractors, assignees, and volunteers performing services under county agreements who will have contact with children must undergo fingerprinting. The fingerprinting requirement is implemented to screen for criminal history that could compromise child safety. The form serves as a template for documenting contractor agreement to this certification requirement and includes fields for the agreement date, contractor name, signatory information, title, and signature with corresponding date.

The fingerprinting certification applies broadly to any county contract involving child contact and represents a standard safety protocol. No pricing terms, contract duration, renewal options, or specific funding amounts are addressed in this certification form, as it functions solely as a compliance and safety documentation instrument. The form does not identify specific contract opportunities, project details, or award information; rather, it establishes a mandatory prerequisite condition for contractors working with children under county agreements.

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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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