Fingerprinting_Certification_Form.pdf
PDF 587 KB Posted
- Solicitation number
- 66600-2526-241
- 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, effective July 1, 2013, applicable to contractors performing services under County agreements. The form establishes a requirement that all contractor employees, subcontractors, assignees, and volunteers who have contact with children during the course of service delivery must undergo fingerprinting to determine criminal history that could compromise child safety. The form includes designated fields for entry of the agreement date, contracting party name, contractor name, title of authorized signatory, signature, and date of execution. This certification applies specifically to the Trauma-Responsive Professional Programs Development contract opportunity with San Mateo Medical Center, a public hospital and clinic system accredited by The Joint Commission that operates acute-care hospital services, outpatient clinics, and long-term care facilities throughout San Mateo County.
No additional pricing terms, set-asides, renewal options, funding amounts, or other financial information is provided in this fingerprinting certification form. The document serves solely as a compliance certification mechanism to ensure child safety protocols are met by all personnel involved in service delivery under County contracts, with no specified contract term or renewal provisions documented in this particular form.
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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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