ITN_10848_Attachment R.docx
DOCX document 39 KB Posted
- Attached to
- CINS/FINS & Statewide Respite Care Services
- Solicitation number
- ITN-09961
- Issued by
- Leon County, Florida
About this file
This file is Attachment R (Certification of Experience) for ITN #10848 from the Florida Department of Juvenile Justice, which is a required form that must be completed by respondents to demonstrate their qualifications and experience. The form requires respondents to provide company information including establishment date, primary business focus, total employee count, number of employees engaged in ITN-relevant activities, and years of experience in managing programs serving vulnerable youth populations.
The form requires respondents to list entities for whom they have provided similar services within the past five years, with respondents needing to demonstrate at least three years of relevant experience during that period. Companies must provide business names, contract manager details, and contact information for these references. The form must be signed by an authorized representative who certifies the respondent's experience in providing services specified in Attachment A (Services Sought) and Attachment A-1 (Statewide Respite Care Services).
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Text version
ITN #10848
ATTACHMENT R
CERTIFICATION OF EXPERIENCE
THIS FORM SHALL BE COMPLETED BY THE RESPONDENT AND SIGNED BY A PERSON AUTHORIZED TO MAKE STATEMENTS ON BEHALF OF THE RESPONDENT. RETURN OF THE COMPLETED AND SIGNED FORM IS A MANDATORY REQUIREMENT.
COMPANY NAME:
DATE ESTBLISHED:
PRIMARY BUSINESS:
TOTAL NUMBER OF EMPLOYEES:
NUMBER OF EMPLOYEES ENGAGED IN ACTIVITIES RELEVANT TO THIS ITN: (NOT INCLUDING LOCAL SERVICE PROVIDERS)
NUMBER OF YEARS OF PROVIDER EXPERIENCE IN SERVICES RELEVANT TO THE PROVISION OF MANAGEMENT AND OVERSIGHT OF PROGRAMS SERVING VULNERABLE YOUTH POPULATIONS:
LIST ENTITIES FOR WHOM THE COMPANY HAS PROVIDED SERVICES WITHIN THE LAST FIVE YEARS, THE DATES OF THE PERFORMANCE (RESPONDENT MUST DEMONSTRATE THREE YEARS EXPERIENCE WITHIN THE LAST FIVE YEARS), THE BUSINESS NAME AND CONTRACT MANAGER’S NAME, PHONE NUMBER AND EMAIL ADDRESS:
I, , CERTIFY THAT THE RESPONDENT KNOWN AS HAS AT LEAST YEARS EXPERIENCE WITHIN THE LAST FIVE YEARS RELEVANT TO THE PROVISION OF SERVICES SPECIFIED IN THE ATTACHMENT A (SERVICES SOUGHT) AND ATTACHMENT A-1 (STATEWIDE RESPITE CARE SERVICES).
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File details come from the government source that posted it. Updated .