RFP 10783_Exhibit 5_.pdf
PDF 55 KB Posted
- Solicitation number
- RFP-04490
- Issued by
- Okaloosa County, Florida
About this file
This document is an Exhibit 5 - Parent/Guardian/Responsible Adult Release Affidavit for the Department of Juvenile Justice's Juvenile Assessment Center procurement. The affidavit requires the parent, guardian, or responsible adult to provide their personal information and attest that the information is true and factual. This document is related to RFP 10783 for the procurement of screening services at the Sarasota Juvenile Assessment Center and the Okaloosa Regional Juvenile Detention Center, issued by the Department of Juvenile Justice, Office of Probation and Community Intervention. The procurement involves the jurisdictions of Leon County and the City of Tallahassee in the state of Florida.
The pricing terms, set asides, incumbent information, funding requirements, and other salient details are not included in this exhibit. However, the contract opportunity involves the provision of juvenile assessment center screening services for the specified jurisdictions and state.
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Other files
| File | Type | Posted |
|---|---|---|
| RFP 10783_Attachment H_BudgetForProbation.xlsx | XLSX spreadsheet | |
| RFP_10783_Attachment Q.pdf | ||
| RFP_10783_V5.pdf | ||
| RFP 10783_Exhibit 4.pdf | ||
| 10783_RFP_ Attachment N.pdf | ||
| 10783_RFP_Attachment_S.pdf | ||
| 10783_RFP_Informational_Notice.pdf |
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Text version
EXHIBIT 5
Department of Juvenile Justice Juvenile Assessment Center
Parent/Responsible Adult Release Affidavit
I, ____________________________________________________ Name attest that I am the _____________________________________of Parent/Guardian/Responsible Adult
________________________________________ whose address is Child’s Name
__________________________________________________, and Address date of birth is ________________________. I may be reached at
DOB
Home Phone Cellular Phone and/ or _________________________.
Pager
Parents Information
Date of Birth ___________________________
Type of Identification provided: ______________________________
I attest that the above information is true and factual.
Signature of Parent/Guardian/Responsible Adult Date
Witness
Reviewed By:
Intake Screener Date
Lead Screener Date
File details come from the government source that posted it. Updated .