RFP_10806_Exhibit5.pdf
PDF 115 KB Posted
- Solicitation number
- RFP-05902
- Issued by
- Okaloosa County, Florida
About this file
This document is an Exhibit from a Request for Proposal (RFP) issued by the Florida Department of Juvenile Justice (DJJ) and the Office of Probation and Community Intervention for the provision of screening services at the Sarasota Juvenile Assessment Center (JAC) Circuit 12 and Okaloosa Regional Juvenile Detention Center (JDC) Circuit 1. The Respondent shall provide staff to perform detention screening services twenty-four (24) hours a day, seven days a week, including weekends and holidays, at these two locations.
The contract opportunity is open to vendors located in the jurisdictions of Leon County and the City of Tallahassee in the state of Florida. No pricing terms, set asides, incumbent information, or funding sources are provided in the document. The document includes a parent/responsible adult release affidavit for the JAC screening services.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| RFP_10806_Addendum_1.pdf | ||
| RFP_10806_AttachmentH_Budget.xlsx | XLSX spreadsheet | |
| RFP_10806_AttachmentN.pdf | ||
| RFP_10806_AttachmentQ.pdf | ||
| RFP_10806_AttachmentS.pdf | ||
| RFP_10806_Exhibit4.pdf | ||
| RFP_10806_Informational_Notice..pdf | ||
| 10806_RFP_V4_Final.pdf | ||
| RFP_10806_Agency_Decision.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 .