LEIN Request REV 04-2018 17471.pdf

PDF 24 KB Posted

Attached to
472/17471. JAG St. Louis CF - Housing Unit Shower Renovations
Solicitation number
RFQ 171 190000000151 3
Issued by
Macomb County, Michigan

About this file

This is a Vendor/Contractor LEIN (Law Enforcement Information Network) Request Form issued by the Michigan Department of Corrections (MDOC) for criminal history clearance purposes. The form is required for vendors and contractors seeking approval to visit or meet with individuals confined in MDOC facilities. The request pertains to a specific project: St. Louis Correctional Facility - Housing Unit Shower Renovations (File #472/17471.JAG). The form collects essential identification information from the vendor or contractor, including full name, address, date of birth, sex, race, and either a driver's license number or state identification card number. This LEIN check must be completed and cleared before the vendor or contractor can gain access to MDOC facilities for project-related activities.

The LEIN check is a mandatory security and safety requirement with no pricing terms, set-asides, or contract funding components addressed in this particular document. The form authorizes MDOC to conduct a criminal history background check using the collected personal identification data. Individuals may obtain copies of their Michigan criminal history through www.michigan.gov/ichat for a fee if needed for reference purposes. Upon completion, MDOC staff documents the check results, including whether the clearance was approved or denied, along with staff initials and completion date.

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St Louis shower specs 1-2-19.pdf PDF
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Photo 341 and 342.PDF PDF
ST LOUIS CORRECTIONAL FACILITY CDs 1-2-19 2 of 2.pdf PDF
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Photo 336 and 337.PDF PDF
Photo 342.PDF PDF
Sign in sheets.PDF PDF

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Text version

MICHIGAN DEPARTMENT OF CORRECTIONS

VENDOR/CONTRACTOR LEIN REQUEST

CAJ-1037

REV. 04/18

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 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 one of the following types of identification:

Driver’s License # State issued by

State ID # State issued by

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: St. Louis Correctional Facility - Housing Unit Shower Renovations File # 472/17471.JAG

File details come from the government source that posted it. Updated .