LEIN Request REV 04-2018 Bid Pkg 3.pdf

PDF 24 KB Posted

Attached to
472/17398. SMD Bid Pkg 3 Razor Ribbon Project - Various CFs
Solicitation number
RFQ 171 180000000615 4
Issued by
Michigan

About this file

This is a LEIN (Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections (MDOC) for Bid Package 3, which encompasses a Razor Ribbon Project at various correctional facilities. The form is designed to collect personal information necessary to conduct criminal history checks for vendors and contractors seeking access to MDOC facilities. Applicants must provide their driver's license number or state identification card number, date of birth, race, and sex, along with at least two additional forms of identification. By signing the form, vendors and contractors authorize MDOC to complete a criminal history check through the Michigan Law Enforcement Information Network as a prerequisite for approval to visit or conduct business with persons confined within Michigan correctional facilities.

This form serves as a mandatory administrative requirement rather than a pricing or contract terms document. Individuals can obtain copies of their Michigan criminal history through the state's official website at www.michigan.gov/ichat, though a fee applies for this service. The LEIN clearance process is completed by designated MDOC staff who verify the check results and document the completion date and initials on the form. All individuals seeking vendor or contractor status with MDOC must successfully clear this criminal background verification before proceeding with facility access or contract engagement related to the Razor Ribbon Project.

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Addendum 1 Bid Pack 3B.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 at least two of the following three 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: Bid Package 3 Various Correctional Facilities - Razor Ribbon Project File # 472/17398.SMD

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