Bid_Intent_Form~16.rtf

BID INTENT S U M M A R Y FORM

DRM 2016-02

Power Plant Systems Management Return to Resource Management NO LATER THAN Thursday, February 25th by noon.

Email this form to Sean Foley at Sean.Foley@MassMail.State.MA.US" Sean.Foley@MassMail.State.MA.US and to Darlene Haigh at Darlene.Haigh@MassMail.State.MA.US" Darlene.Haigh@MassMail.State.MA.US

Date:

I plan to attend the site visit for the above referenced project. I am providing the following information for clearance approval, as required.

The following information is on the employee(s) who will be attending the site visit:

Driver’s

Is Background Employee Name (Print) Date of Birth License No. * State Info attached?

Yes

Company Name (Print/Type)

Individual Completing this Form (Print/Type) Your Signature

Street

City

State

Zip Code

Telephone Number Fax Number

* Note: Some states use your Social Security Number as a Driver’s License Number. If this is the case, you are requested to volunteer this information to be used solely as an aid in the investigation process.

IMPORTANT NOTE: The interested bidder must also submit the “BACKGROUND INFORMATION REQUEST AND WAIVER” form for each employee listed above.

Bidders may call Giovanni at (978) 369-8899 ext. 12 to verify receipt of the email. The Department takes no responsibility for emails that were not successfully received by the Department.

BACKGROUND INFORMATION REQUEST and WAIVER

DRM 2016-02

Power Plant Systems Management Return to Resource Management NO LATER THAN Thursday, February 25th by noon.

INSTITUTION / DIVISION

DATE:

(Leave blank)

CONTRACT EMPLOYEE

X

PERSONAL DATA

(Please PRINT clearly or TYPE)

NAME:

Last First Initial

Previous name and/or alias:

Residential Address:

(Not a P.O.Box number) Number Street City St Zip

Have you ever resided in another State?

If “YES”, which state (s)?

* Note: Some states use your Social Security Number as a Driver’s License Number. If this is the case, you are requested to volunteer this information to be used solely as an aid in the investigation process.

Enter your current Drivers License No (Voluntary)*:

Your current Driver’s License is issued from which state?

Date of birth:

Place of birth:

Mother’s Maiden Name:

Father’s Name:

I, hereby release, discharge, and exonerate the Massachusetts Department of Correction, its agents and representatives, and any person so furnishing information, for any and all liability of every nature and kind arising out of the furnishing or inspection of such documents, records and other information made by or in behalf of the Massachusetts Department of Correction.

I further understand that the Department of Correction will conduct a background investigation that will include a criminal records check with the local police department, the State Police, the FBI in Washington, D.C., the Massachusetts Board of Probation, and the Registry of Motor Vehicles.

* You are requested to volunteer your Social Security Number at the right to aid in this background investigation

SIGNATURE:

CRIMINAL RECORD CHECK ONLY

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Massachusetts Department of Correction Volunteer and Contractor Training and Acknowledgement of Prison Rape Elimination Act (PREA) - Attachment IV file_2.png file_3.bin thumbnail_0.emf file_4.bin thumbnail_1.wmf

I have been informed of and understand each of the following specific items about the PRISON RAPE ELIMINATION ACT (PREA) of 2003 listed below:

(1) Federal law specific to incarcerated persons, the Prison Rape Elimination Act (PREA) of 2003, requires that the Department of Correction (DOC) take steps to prevent staff-on inmate and inmate on inmate sexual contact of any type from occurring in or around DOC facilities and/or property.

(2)

The Department has zero tolerance toward all forms of sexual abuse and sexual harassment and is committed to preventing, detecting, and responding to such conduct as outlined in 103 DOC 519 - SEXUALLY ABUSIVE BEHAVIOR PREVENTION AND INTERVENTION POLICY. The Department embraces the standards set forth by the National Prison Rape Elimination Commission and the American Correction Association for all state correctional jurisdictions.

(3)

State and Federal law specific to incarcerated persons forbids sexual contact of any type or kind whatsoever by an employee/volunteer or contractor in or around DOC facilities and/or property

(4)

Sexual misconduct between an employee/volunteer or contractor and an inmate is forbidden and may result in discipline up to and including termination and referring for prosecution Department employees, contractors, volunteers and inmates who engage in sexually abusive behavior. Sexual misconduct can consist of conversations, gestures, or correspondence of a sexual nature. This includes demeaning references to gender or sexual preference, or sexually suggestive or derogatory comments about body or clothing, or obscene language or gestures. Sexual misconduct also includes voyeurism which is an invasion of an inmate’s privacy by peering at an inmate in private situations outside of those required by supervisory or security policies and procedures.

(5)

I have a duty to report any sexual misconduct between an employee, volunteer or contractor and an inmate that I observe or have reason to believe occurred and must report it to the Shift Commander as required. If I fail to do so and such is proven pursuant to policy, there could be disciplinary action up to and including termination and/or criminal action.