LEIN Request 17042.pdf
PDF 24 KB Posted
- Solicitation number
- RFQ 171 180000000347 3
- Issued by
- Alger County, 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. The form is required for individuals seeking approval to visit or conduct business within Michigan Department of Corrections facilities. The specific project associated with this request is the Alger Correctional Facility Propane Plant Replacement, which involves repairing the back-up fuel system blender (File #472/17042.TAP). The form requires contractors and vendors to provide personal identification information, including driver's license number or state identification card number, social security number, date of birth, race, and sex. Authorization for the criminal history check must be obtained through contractor signature before facility access can be granted.
The LEIN clearance process is a mandatory prerequisite for any vendor or contractor activity at MDOC facilities and does not involve pricing terms, set-asides, or contractual renewal options. Individuals may obtain a copy of their Michigan criminal history through www.michigan.gov/ichat for a fee if they wish to review results independently. The form indicates that the LEIN check must be completed and cleared before the vendor or contractor can be approved for facility access, with the clearance documented by MDOC staff initials and date upon completion.
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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 http://www.michigan.gov/ichat hallt2 Text Box Facility/Project Name: Alger Correctional Facility - Propane Plant Replacement/ Repair the back-up fuel system blender File # 472/17042.TAP
File details come from the government source that posted it. Updated .