Fingerprinting_Certification_Form.pdf
PDF 587 KB Posted
- Attached to
- Overpayment Resolution Services
- Solicitation number
- 66000-2526-225
- 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, applicable to contractors and service providers working with San Mateo Medical Center. The form establishes a requirement that all contractor employees, subcontractors, assignees, and volunteers who have contact with children during the performance of services must undergo fingerprinting to identify any criminal history that could compromise child safety. The form includes fields for the date of agreement, agreement counterparty, contractor name, title, signature, and date of execution. This certification requirement applies to the Overpayment Resolution Services contract (RFP No. 66000-2526-225), which was released on November 17, 2025, with a proposal deadline of December 19, 2025, at 1:00 pm. The resulting contract will have a five-year term with no pre-proposal conference or site visit scheduled.
The fingerprinting certification is a mandatory compliance requirement for contractor personnel with potential child contact, separate from other compliance obligations including HIPAA Business Associate regulations, Section 504 accessibility compliance, and adherence to the county's corporate compliance code of conduct. This requirement reflects San Mateo County's commitment to protecting vulnerable populations served by the medical center's clinics and facilities throughout the county. Proposers must ensure all applicable personnel complete the fingerprinting certification process as a condition of contract performance.
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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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