Bid_Intent_Form~2.doc

BID INTENT S U M M A R Y FORM

DRM 2018-46 #8

Conduit Installation, 1 Barretts Mill Road, Concord, MA 01742 Return to the Department of Correction, Division of Resource Management NO LATER THAN 12:00PM, Friday, August 26, 2022.

E-Mail to Darlene.Keane@State.MA.US Department of Correction - Central Headquarters

Division of Resource Management

50 Maple Street Milford, MA 01757

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

Yes

Yes

Yes

Company Name (Print/Type)

Street

City

State

Zip Code

* 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.

**Please Note: The following items are not allowed to be worn by any visitor when entering a Massachusetts Correctional Facility: No jeans, no logo shirts, no hoodies. No cell phones are allowed in the facilities.

The Department takes no responsibility for documents that were not successfully received by the Department.

BACKGROUND INFORMATION REQUEST and WAIVER

DRM 2018-46 #8

Conduit Installation, 1 Barretts Mill Road, Concord, MA 01742 Return to the Department of Correction, Division of Resource Management NO LATER THAN 12:00PM, Friday, August 26, 2022.

INSTITUTION / DIVISION

DATE:

(Leave blank)

CONTRACT EMPLOYEE

X

NAME:

Previous name and/or alias:

Residential Address:

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?

Place of birth:

Mother’s Maiden Name:

Father’s Name:

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 ( (

**Please Note: The following items are not allowed to be worn by any visitor when entering a Massachusetts Correctional Facility: No jeans, no logo shirts, no hoodies. No cell phones are allowed in the facilities.

SIGNATURE:

CRIMINAL RECORD CHECK ONLY

Volunteer and Contractor Training and Acknowledgement of Prison Rape Elimination Act (PREA) - Attachment IV

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

(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.

Print Name

Company

Signature

Date

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