Fingerprinting_Certification_Form.pdf
PDF 587 KB Posted
- Attached to
- FOHC Lobbies AV
- Solicitation number
- 66600-2526-236
- 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, applicable to contractors performing services under county agreements. The form documents the contractor's agreement that all employees, subcontractors, assignees, and volunteers who have contact with children during service delivery will undergo fingerprinting to identify any criminal history that could compromise child safety. The form serves as a compliance certification and includes fields for the agreement date, contractor name, title of the authorizing representative, signature, and date of issuance by the County of San Mateo Contract Compliance Committee, effective July 1, 2013.
This fingerprinting requirement applies directly to the FOHC Lobbies AV contract opportunity with San Mateo Medical Center. Contractors responding to this audiovisual system installation project must ensure compliance with this certification if any contractor personnel or subcontractor staff will have contact with children at Fair Oaks Health Center. The fingerprinting certification is one of several mandatory compliance requirements contractors must fulfill, alongside HIPAA Business Associate obligations, Living Wage Ordinance compliance, Section 504 Rehabilitation Act adherence, and corporate compliance code of conduct standards. All successful contractors and subcontractors must maintain comprehensive insurance coverage, including workers' compensation and liability insurance minimums of $1,000,000 each.
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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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