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 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, APL Index Code 46630). The project requires all vendors and contractors to complete a criminal history background check through the Michigan Law Enforcement Information Network prior to accessing Michigan Department of Corrections facilities. Pre-bid site walk-through dates were scheduled for September 18, 2017 at 10:30 a.m. and October 25, 2017 at 1:00 p.m. The form requires submission of personal identification information including driver's license or state identification card number, social security number, date of birth, race, and sex to facilitate the LEIN clearance process.
The LEIN clearance must be completed and approved before vendors or contractors may visit or meet with individuals confined in Michigan Department of Corrections facilities. Individuals may obtain a copy of their Michigan criminal history through www.michigan.gov/ichat for a fee. The form includes authorization language whereby applicants consent to the criminal history check and provides space for facility staff to document the LEIN check status, including clearance approval or denial, and the date the check was completed.
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Other files
| File | Type | Posted |
|---|---|---|
| 16419 Addendum 2.pdf | ||
| 16419 Addendum 4.pdf | ||
| IMPORTANT NOTICE - SIGMA VSS 170830.pdf | ||
| 16419 Addendum 1 R pgs 34-67.pdf | ||
| Wage Rates (Updated).pdf | ||
| Specifications.pdf | ||
| Advertisement.pdf | ||
| Drawings.pdf | ||
| 16419 Addendum 6R.pdf | ||
| 16419 Addendum 1 R pgs 1-33.pdf | ||
| 16419 Addendum 3.pdf | ||
| 16419 Addendum 5.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 .