AFFIDAVIT OF CRIMINAL BACKGROUND SCREENING VENDOR NAME DATE By signing this form I am swea

Document Sample
AFFIDAVIT OF CRIMINAL BACKGROUND SCREENING VENDOR NAME DATE By signing this form I am swea Powered By Docstoc
					                 AFFIDAVIT OF CRIMINAL BACKGROUND SCREENING



VENDOR NAME: _________________________________________________

DATE: __________________________

By signing this form, I am swearing or affirming that all individuals employed by
____________________________________ (VENDOR) or providing services to COUNTY
under the Vendor Permit Application on behalf of VENDOR on County Park Property have been
background screened in accordance with the background screening requirements set forth in
the Vendor Permit Application and been deemed eligible by VENDOR to provide services as
described in the Vendor Permit Application. The information contained in this Affidavit is up to
date as of the date this Affidavit is furnished to COUNTY’s Park Office per the requirements of
Section 6 of the Vendor Permit Application.

All individuals providing services under the Vendor Permit Application on County Park Property
are listed below. Each individual shall be identified by name, birth date and date deemed
eligible.

       [Insert list of individuals]




______________________________
Signature of Affiant

Sworn to and subscribed before me this ____ day of __________________, 20__.

____________________                  _________________________________
My commission expires:                NOTARY PUBLIC, STATE OF FLORIDA

My signature, as Notary Public, verifies the Affiant’s identification has been validated by

_____________________________________________________________________.




Form 501-204V Vendor Criminal Background Screening Affidavit (11/09)

				
DOCUMENT INFO
Description: Criminal Affidavit Form document sample