Fingerprinting_Certification_Form.pdf
PDF 587 KB Posted
- Attached to
- Provider Time Tracking, Invoicing and Approval
- Solicitation number
- 66600-2526-240
- 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, a California jurisdiction, designed to ensure the safety of children served under county contracts. The form establishes a requirement that all contractor employees, subcontractors, assignees, and volunteers who have contact with children during service delivery must undergo fingerprinting to screen for criminal histories that could compromise child safety. The form is a template document issued by the County of San Mateo Contract Compliance Committee on July 1, 2013, and requires contractor signatures and dates of certification.
The form serves as a compliance mechanism within the broader Provider Time Tracking, Invoicing and Approval RFP issued by San Mateo Medical Center, a Joint Commission-accredited public hospital and clinic system operated by the County of San Mateo. While the fingerprinting requirement applies to contractors providing services involving child contact, the RFP itself encompasses a five-year software development contract with a proposal deadline of April 1, 2026, at 1:00 p.m. Contractors must comply with all applicable federal, state, and local requirements, including HIPAA regulations, and maintain specified insurance coverage. No specific pricing information, award value, or budget range is disclosed in the available procurement documents, and preferential scoring of up to 10 points may be awarded to local businesses or non-profit organizations.
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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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