Fingerprinting_Certification_Form.pdf
PDF 587 KB Posted
- Solicitation number
- 66000-2526-238
- 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 who have contact with children during the performance of services under County agreements. The form, issued by the County of San Mateo Contract Compliance Committee, documents the contractor's agreement to fingerprint all personnel with child contact to determine criminal history and assess potential risks to child safety. The form contains fields for the date of execution, the agreement counterparty, the contractor's name and title, and authorized signature, serving as a compliance document template for County procurement activities.
This fingerprinting requirement is specifically mandated for the Fixed and Removable Prosthesis for Dental Patients contract opportunity with San Mateo Medical Center, where dental laboratory services are provided. The fingerprinting certification must be completed prior to contract award or performance, as it constitutes part of the County's comprehensive compliance framework. The form represents one of multiple regulatory requirements contractors must satisfy, alongside HIPAA compliance, Section 504 compliance, workers' compensation insurance, professional liability insurance, and adherence to the County's Corporate Compliance Code of Conduct. Contractors should complete and submit this certification form as directed in the RFP instructions, with proposals due March 6, 2026 at 1:00 p.m. via the eProcurement portal.
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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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