01 - CAJ-1037 Vendor-Contractor LEIN Request - 2018 DTMB.pdf
PDF 165 KB Posted
- Solicitation number
- RFQ - 171 - 230000000448
- Issued by
- Ionia County, Michigan
About this file
The document is a Michigan Department of Corrections Vendor/Contractor LEIN Request form, which is used to conduct criminal history checks for individuals seeking approval to visit or meet with persons confined in a Michigan Department of Corrections facility. The related state and local contract opportunity is for the Handlon/Ionia Correctional Facility Bar Screen and Grinder Upgrades, Project File No. 472/20205.SMD. The project requires vendors to submit bids electronically through the SIGMA VSS system, and all questions should be emailed to the project contact, Joe Sovis. Bid submissions have a deadline of 2:00 PM, and emailed submissions may be considered on a case-by-case basis with prior approval from the Office of Design and Construction.
The contract opportunity does not provide details on pricing terms, set asides, incumbents, funding requirements, or other salient information. The focus is on the bid submission process and LEIN requirements for vendor access to the correctional facility.
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Text version
MICHIGAN DEPARTMENT OF CORRECTIONS
VENDOR/CONTRACTOR LEIN REQUEST
CAJ-1037
REV. 04/18
Please provide the information requested below. This information will be used to complete a criminal history check in the Michigan Law Enforcement Information Network (LEIN).
Your Driver’s License Number or State Identification Card Number is needed to complete this LEIN. Also needed are your date-of-birth, race and sex. Potential entry into MDOC facilities require that this LEIN check be completed and cleared.
I authorize the Michigan Department of Corrections to conduct a criminal history check, so that I may be approved to visit/meet with persons confined in a Michigan Department of Corrections facility.
Signature Date
Staff Use Only
Reason for LEIN Check
Staff requesting LEIN Check
LEIN Checked by
LEIN Clear Yes No, You may obtain a copy of your Michigan criminal history at www.michigan.gov/ichat. There is a fee for this service.
LEIN Check completed by Initials Date
Profession Vendor Contractor
Last Name (Please Print)
First Name Middle Name
Address
City State Zip Code
Date of Birth Sex Race
Please provide the number of one of the following types of identification:
Driver’s License # State issued by
State ID # State issued by
Handlon / Ionia Correctional Facility - Bar Screen and Grinder Upgrades File No: 472/20205.SMD http://www.michigan.gov/ichat
State of Michigan Matrix Consulting Engineers, Inc.
Department of Technology, Management and Budget Design and Construction Division Handlon / Ionia Correctional Facility Bar Screen and Grinder Upgrades File No: 472/20205.SMD Funding Code No.: 472MTUMaintProj
THIS PAGE IS LEFT BLANK INTENTIONALLY
| VENDOR/CONTRACTOR LEIN REQUEST |
| I authorize the Michigan Department of Corrections to conduct a criminal history check, so that I may be approved to visit/meet with persons confined in a Michigan Department of Corrections facility. |
File details come from the government source that posted it. Updated .