26156.MDL Chippewa CF Sanitary Swr. & Infrastructure - MDOC-LEIN_RequestForm.pdf
PDF 83 KB Posted
- Solicitation number
- RFQ 171 270000000012 4
- Issued by
- Michigan
About this file
This is a Local Energy Investment Network (LEIN) Request Form submitted to the State of Michigan for the Chippewa Correctional Facility Sanitary Sewer Upgrades project (472/26156.MDL). The project involves infrastructure improvements to the sanitary sewer system at the Chippewa Correctional Facility. The form documents the funding request and project details necessary for state consideration and approval of this infrastructure upgrade initiative.
The document serves as an official request to access Michigan's LEIN program funding for the proposed sanitary sewer infrastructure improvements at the correctional facility. Specific details regarding project costs, timeline, scope deliverables, bid procedures, and award terms would be contained within the supporting documentation accompanying this request form. The LEIN program provides a mechanism for eligible projects to secure state funding for energy and infrastructure improvements that enhance facility operations and efficiency.
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Text version
MICHIGAN DEPARTMENT OF CORRECTIONS
LEIN REQUEST
CAJ-1037.
REV. 09/19.
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, date-of-birth, race and sex is needed to complete this LEIN request.
Employment/Human Resources HR Personnel / Requesting
Contractor Visitor
Contractor Agency Agency Representing
Volunteer Other Agency Representing Agency Representing
Are you entering the secure perimeter/property of a Michigan Department of Corrections (MDOC) facility? Yes No
Please print information below:
Last Name: 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:
I authorize the MDOC to conduct a criminal history check, so that I may be approved to enter the secure perimeter/property of an MDOC facility to perform work, visit, meet with or work with MDOC offenders.
For MDOC HR/Employment purposes only: I further authorize the Department to check my motor vehicle operator license record for the purposes of determining if I will be allowed to operate a motor vehicle while conducting Department business.
Signature: Date:
LEIN Completed By: Name: Date:
LEIN Cleared: Yes No (Does not apply to Human Resources)
MDOC Employment/HR purposes: Indicate the # of convictions:
Comment (Optional):
File details come from the government source that posted it. Updated .