Fingerprinting_Certification_Form.pdf
PDF 587 KB Posted
- Attached to
- After-Hours Pharmacy Remote Order Entry Services
- Solicitation number
- 66000-2425-201
- 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, applicable to contractors and their employees, subcontractors, assignees, and volunteers working on county agreements. The form establishes a requirement that all personnel with contact to children during service delivery must undergo fingerprinting to determine criminal history and assess potential risks to child safety. The certification form is a template document that requires completion with the agreement date, contractor name, signatory name and title, and signature of authorization, with the form originally issued on July 1, 2013.
This document serves as a compliance certification mechanism rather than a procurement request and does not specify pricing terms, contract amounts, set-asides, or service delivery periods. The form applies broadly to any County of San Mateo contract involving child contact and represents a mandatory safety screening requirement. Based on the related contract opportunity for After-Hours Pharmacy Remote Order Entry Services, this fingerprinting requirement would apply if contractor personnel have any contact with pediatric patients or children at San Mateo Medical Center facilities during service delivery under the $1,000,000 five-year contract with a June 26, 2025 proposal deadline.
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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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