Bid Intent Form~5.pdf

Bid Intent Summary Form Project: DRM 2026-20 Housing Units A, B, and C Roof Replacements

Location: BSH, 20 Administration Road, Bridgewater, MA 02324

Bid Intent Form Due Date: November 10, 2026, 12:00PM

Due To: DOC-DRMBidRequests@doc.state.ma.us

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:

Employee Name (Print) D.O.B

Driver’s License No.* State Is Background Info Attached?

* 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.

Company Name: ___________________________________________________________________

Individual Name (Print): _____________________________________________________________

Signature: __________________________________________________________________________

Address (Street, City, State, Zip Code): ______________________________________________

Telephone Number: ________________________________________________________________

**Please Note: The following items are not allowed to be worn by any visitor when entering a Massachusetts Correctional Facility: Jeans, Logo Shirts, Hoodies.

BACKGROUND INFORMATION REQUEST and WAIVER Project: ______________________________ Location:_________________________

Bid Intent Due Date: ___________________ To: DOC-DRMBidRequests@doc.state.ma.us

Institution/Division: ____________________ Date:______________

Contract Employee: ________________________________

Personal Data

Name (First, Last, Middle Initial):____________________________________________________

Previous name and/or Alias:_________________________________________________________

Residential Address (Street, City, State, Zip Code):___________________________________

Have you ever lived in another State?:_______________ If “Yes”, Which states:__________

Enter your current Drivers License No (Voluntary)*:__________________________

* 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.

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

D.O.B.:____________________ Place of Birth:______________________________

Mother’s Maiden Name:_________________________________________________

Father’s Name:_________________________________________________________

*You are requested to volunteer your Social Security Number to aid in this background investigation:____________________________________________________________________

I, _______________________________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.

Signature:__________________________________________________________________________________

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.

Massachusetts Department of Correction

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:

(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.

Print Name: _____________________________________ Company :______________________

Signature:_______________________________________ Date:___________________________