LEIN Form 16419.pdf
PDF 62 KB Posted
- Solicitation number
- RFQ-171-180000000018-3
- Issued by
- Wayne County, Flint City, Michigan
About this file
This is a Michigan Department of Corrections (MDOC) Vendor/Contractor LEIN (Law Enforcement Information Network) Request form (CAJ-1037) associated with the Saginaw Correctional Facility Entrance Door Replacement and Masonry Repairs project (File #472/16419.APL, Index Code 46630). The document relates to a pre-bid walk-through scheduled for September 18, 2017, at 9:30 A.M. This form is required for potential vendors and contractors who need access to MDOC facilities as part of the bidding process.
The form requires personal identification information including name, address, date of birth, sex, race, and at least two forms of identification from among driver's license, state ID, or Social Security number. The form includes an authorization for MDOC to conduct a criminal history check through LEIN, which must be completed and cleared before facility access is granted. The bottom portion includes a staff-use section for recording the LEIN check results, with an option for individuals to obtain their Michigan criminal history through www.michigan.gov/ichat if needed (for a fee).
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Other files
| File | Type | Posted |
|---|---|---|
| Addendum 1 Part 2 16419.pdf | ||
| Addendum 1 Part 1 16419.pdf | ||
| Advertisement 16419.pdf | ||
| IMPORTANT NOTICE - SIGMA VSS.docx | DOCX document | |
| Specifications 16419.pdf | ||
| Drawings 16419.pdf | ||
| SIGMA Notice (Buy4Michigan Language) 16419.pdf |
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Text version
MICHIGAN DEPARTMENT OF CORRECTIONS
VENDOR/CONTRACTOR LEIN REQUEST
CAJ-1037
REV. 03/15
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 and your Social Security Number is needed to complete this LEIN. Also needed are your date-of-birth, race and sex. Potential entry into MDOC facilities require that this LEIN check be completed and cleared.
Profession Vendor Contractor
Last Name (Please Print)
First Name Middle Name
Address
City State Zip Code
Date of Birth Sex Race
Please provide the number of at least two of the following three types of identification:
Driver’s License # State issued by
State ID # State issued by
Social Security #
I authorize the Michigan Department of Corrections to conduct a criminal history check, so that I may be approved to visit/meet with persons confined in a Michigan Department of Corrections facility.
Signature Date
Staff Use Only
Reason for LEIN Check
Staff requesting LEIN Check
LEIN Checked by
LEIN Clear Yes No, You may obtain a copy of your Michigan criminal history at www.michigan.gov/ichat. There is a fee for this service.
LEIN Check completed by Initials Date
.Facility/Project Name:
SAGINAW CORRECTIONAL FACILITY
ENTRANCE DOOR REPLACEMENT AND MASONRY REPAIRS.
File # 472/16419.APL
INDEX CODE: 46630
PRE-BID WALK-THROUGH
DATE: SEPTEMBER 18, 2017 TIME: 9:30 A.M.
http://www.michigan.gov/ichat
File details come from the government source that posted it. Updated .