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

_____________________________________________________________________.