Site Visit Forms.pdf

Good morning, All vendors that wish to attend the site visit at FCI Marianna on September 27, 2023 at 9:00 am central time need to complete the attached forms and return them to the following by Thursday, September 21, 2023 at 4:00 pm central time. This is to allow time to run the necessary checks before the site visit.

Thomas Flowers – tflowers@bop.gov

Newton Brock – nbrock@bop.gov

The address to the institution is:

3625 FCI Road

Marianna, FL 32446

We will meet vendors at the front entrance to the institution just before 9:00 am central time on the date of the visit, and escort to the location.

Thank you, Kenneth Stewart

Contract Specialist

(850)526-6358 mailto:tflowers@bop.gov mailto:nbrock@bop.gov

PDF Prescribed by P1280

BP-A0660 CRIMINAL HISTORY CHECK

MAY 18

U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS

AUTHORIZATION FOR RELEASE OF INFORMATION

CRIMINAL HISTORY C HECK

I hereby authorize a representative of the Federal Bureau of Prisons to obtain information on my criminal history background. I understand that this check must be done before I am allowed to enter/serve at any Bureau facility. I also understand that refusal to provide all necessary information may result in (1) denial of entry into a Bureau facility and (2) denial of volunteer/contract status.

1. Name (Last, First, Middle)

2. Address (Street address — City, State, County, Zip Code)

3. Home Telephone Number (Area Code, Number):

4. Aliases/Nickname:

5. Citizenship (List the country you are a citizen of):

6. Social Security Number:

7. Date of Birth (Month, day, year):

8a. Sex: 8b. Race:

8c. Height: 8d. Weight:

8e. Color of Eyes: 9f. Color of Hair:

9. Place of Birth (City, State, County) List city, county, and country if outside the U.S.A.

10. The above- listed information is true and correct.

Applicant’s Signature

10a. Date

PRIVACY ACT NOTICE

Authority for Collecting Information: E.O. 10450; 5 USC 1303-1305; 42 USC 2165 and 2455; 22 USC 2585 and 2519;

and 5 USC 3301

Purposes and Uses: Information provided on this form will be furnished to individuals in order to obtain information regarding activities in connection with an investigation to determine (1) fitness for Federal employment, (2) clearance to perform contractual service for the Federal Government, (3) security clearance or access. The information obtained may be furnished to third parties as necessary in the fulfil lment of official responsibilities.

Effects of Non-Disclosures: Furnishing the requested information is voluntary, but failure to provide all or of part the information may result in lack of further consideration for employment, clearance or access, or in the termination of your employment.

NCIC and.Attch.10.pdf