Fingerprinting_Certification_Form.pdf

This is a Fingerprinting Certification Form issued by the County of San Mateo Contract Compliance Committee, effective July 1, 2013, applicable to contractors and service providers working with San Mateo Medical Center. The form establishes a requirement that all contractor employees, subcontractors, assignees, and volunteers who have contact with children during the performance of services under a contract must undergo fingerprinting to determine whether they possess a criminal history that could compromise child safety. The form includes fields for the agreement date, contractor name, signatory name and title, and signature and date of authorization.

The fingerprinting certification requirement applies broadly to any individual with child contact during service delivery and serves as a pre-employment or pre-engagement screening mechanism. No specific pricing, award dates, contract terms, or renewal options are addressed in this form, as it functions as a standard compliance and safety certification document that must be executed as part of contract administration procedures for County of San Mateo agreements involving child-facing services.