LEIN Form.pdf
PDF 42 KB Posted
- Solicitation number
- RFQ-171-180000000086-9
- Issued by
- Saginaw County, Flint City, Michigan
About this file
This is a Michigan Department of Corrections (MDOC) LEIN (Law Enforcement Information Network) Request Form (CAJ-1037) for vendors and contractors associated with the Saginaw Correctional Facility Entrance Door Replacement and Masonry Repairs project (File #472/16419.APL, Index Code 46630). The document shows multiple pre-bid walk-through dates, with the final date being October 25, 2017, at 1:00 pm. The form is required for criminal history checks of vendors and contractors who need access to MDOC facilities.
The form requires vendors/contractors to provide personal identification information including driver's license number or state ID, social security number, date of birth, race, and sex. The document includes sections for staff use to record the reason for the LEIN check, staff requesting the check, who performed the check, and whether the check was cleared. If not cleared, applicants can obtain their Michigan criminal history through www.michigan.gov/ichat for a fee.
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Other files
| File | Type | Posted |
|---|---|---|
| 16419 Addendum 4.pdf | ||
| Drawings.pdf | ||
| 16419 Addendum 1 R pgs 1-33.pdf | ||
| IMPORTANT NOTICE - SIGMA VSS 170830.pdf | ||
| 16419 Addendum 2.pdf | ||
| Advertisement.pdf | ||
| 16419 Addendum 3.pdf | ||
| Specifications.pdf | ||
| 16419 Addendum 6R.pdf | ||
| Wage Rates (Updated).pdf | ||
| 16419 Addendum 5.pdf | ||
| 16419 Addendum 1 R pgs 34-67.pdf |
Show all 12
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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: 10:30 A.M.
elow. This information will be used to complete a
.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: 10:30 A.M.TIME: 9:30 A.M.
Facility / Project Name:
SAGINAW CORRECTIONAL FACILITY
ENTRANCE DOOR REPLACEMENT AND MASONRY REPAIRS
File #: 472 / 16419.APL
INDEX CODE: 46630
PREBID SITEWALK THROUGH
DATE: OCTOBER 25, 2017, @ 1:00 pm http://www.michigan.gov/ichat Pfindlan Snapshot
Pfindlan Polygon
File details come from the government source that posted it. Updated .