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 from the County of San Mateo, 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 identify criminal histories that could compromise child safety. The document serves as a template for contractors to acknowledge and certify compliance with this background screening mandate. The form includes fields for the agreement date, contracting entity name, contractor representative identification, and signature authorization, and was issued by the County of San Mateo Contract Compliance Committee effective July 1, 2013.

In the context of the related teleneurology services RFP for San Mateo Medical Center, this fingerprinting requirement applies as part of the broader background security check mandate specified in the solicitation. All contractor employees must undergo background security checks as a condition of engagement. The teleneurology RFP, released February 18, 2026, with proposals due March 11, 2026, requires vendors to comply with comprehensive regulatory requirements including HIPAA obligations, the County's Corporate Compliance Code of Conduct, and various insurance and cybersecurity standards. The contract term is set for one year with no renewal options specified, and pricing has not been disclosed as part of the solicitation materials.

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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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