LEIN Form 16419.pdf
PDF 62 KB Posted
- Solicitation number
- RFQ 171 180000000018 3
- Issued by
- Saginaw County, Flint City, Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request Form issued by the Michigan Department of Corrections for vendor and contractor criminal history clearance related to the Saginaw Correctional Facility Entrance Door Replacement and Masonry Repairs project (File #472/16419). The form requires vendors and contractors to provide personal identification information including driver's license or state identification card number, social security number, date of birth, race, and sex to facilitate a mandatory criminal history check. A pre-bid walk-through for the project is scheduled for September 18, 2017 at 9:30 a.m. Completion and clearance of the LEIN check is a prerequisite for any potential entry into Michigan Department of Corrections facilities.
The LEIN form requires submission of at least two of three identification types (driver's license, state ID, or social security number) and authorization signature from the vendor or contractor. The criminal history check is performed by MDOC staff and results are documented on the form with clearance status marked as either "Yes" or "No." Individuals may obtain copies of their Michigan criminal history through the state's ICHAT system at www.michigan.gov/ichat for a fee. This clearance process is mandatory for all vendors and contractors seeking to access or work within MDOC facilities for this project.
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Other files
| File | Type | Posted |
|---|---|---|
| Advertisement 16419.pdf | ||
| SIGMA Notice (Buy4Michigan Language) 16419.pdf | ||
| Specifications 16419.pdf | ||
| Drawings 16419.pdf | ||
| Addendum 1 Part 1 16419.pdf | ||
| IMPORTANT NOTICE - SIGMA VSS.docx | DOCX document | |
| Addendum 1 Part 2 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 .