OMB-MC3806000026-AD1.pdf
PDF 2 MB Posted
- Attached to
- Hazel D. Plant Ats & Generator Replacement
- Solicitation number
- OMB-MC3806000026
- Issued by
- New Castle County, Delaware
About this file
This document is Pre-Bid Meeting Minutes and Addendum No. 1 for the Delaware Department of Correction, issued by the State of Delaware Office of Management and Budget Division of Facilities Management. The project involves replacement of a 150-kilowatt diesel-driven emergency generator with a natural gas unit and replacement of two automatic transfer switches at the Hazel D. Plant Women's Treatment Facility located at 620 Baylor Boulevard in New Castle, Delaware. The mandatory pre-bid meeting was held on September 29, 2026 at 10:00 AM at the Haslet Armory Building with representatives from multiple electrical, mechanical, and construction firms in attendance. Sealed bids are due by 1:00 PM on October 29, 2026, with submission available through the Bonfire Portal at https://DFM.bonfirehub.com or in person at 122 Martin Luther King Jr. Boulevard South, Dover, Delaware. Bids will be publicly opened and read aloud at 2:00 PM on October 29, 2026 at the Haslet Armory. A site walkthrough is scheduled for 9:00 AM on October 8, 2026 for registered attendees with a maximum of three representatives per contractor. Only contractors in attendance at the mandatory pre-bid meeting are eligible to submit bids as prime bidders. The successful contractor must complete the project within a specified number of calendar days from the date of purchase order receipt and achieve substantial completion within that timeframe, with a two-year warranty required on all work and materials beginning from the date of substantial completion.
The base bid shall include all work shown in the contract documents with two allowances: $25,000 for unforeseen system modifications and $15,000 for utility company costs. Bid security must equal ten percent of the total bid amount and remain valid for thirty days from the date of bid opening. The project is subject to Delaware prevailing wage requirements for New Castle County under the Heavy Construction Classification, with wage rates effective March 15, 2026, and contractors must file weekly sworn payroll reports. All bidders must be registered plan holders, submit a completed subcontractor list identifying contractors for electrical, mechanical, and concrete work with full names and addresses, provide notarized affidavits confirming employee drug testing programs and contractor qualifications, and submit a non-collusion statement. Work is restricted to 7:00 AM to 3:00 PM Monday through Friday, with all on-site personnel requiring background check approval and security clearance. The facility operates as a correctional facility with restricted 24/7/365 access requiring Department of Correction escorts, and all contractors must establish a lockable job box, provide a portable toilet, and comply with a tobacco-free facility policy. The deadline for substitution requests is October 19, 2026 at 1:00 PM, and the deadline for written questions is October 23, 2026 at 1:00 PM, with only answers provided via addendum being binding.
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Other files
| File | Type | Posted |
|---|---|---|
| OMB-MC3806000026-WAGES.pdf | ||
| OMB-MC3806000026-Exemption From Plan Publication.pdf | ||
| OMB-MC3806000026-RFP.pdf | ||
| OMB-MC3806000026-SPECS.pdf |
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PRE-BID MEETING MINUTES-ADDENDUM NO. 1
HDP GENERATOR & ATS REPLACEMENT
DELAWARE DEPARTMENT OF CORRECTION
HAZEL D. PLANT WOMEN’S TREATMENT FACILITY
620 BAYLOR BLVD, NEW CASTLE, DE 19720
OMB/DFM PROJECT #: MC380600026
A Mandatory Pre-Bid Meeting was held at the Haslet Armory Building, Main Conference Room on Tuesday, September 29, 2026 at 10:00 AM. Those in attendance were:
Brian Cotner OMB/Division of Facilities Management Josh Morris B.W. Electric, Inc.
Ricky Messick J&B Electrical Thomas O’Flynn Superior Electric Avery White Diamond Electric Kim Lombardi Amakor, Inc.
Lisa Nichols Fidelity Power Systems Chidozie Dike DK Construction Services, LLC Robert Bolen Battaglia Bryan Smith Filec Services Matt Bailey Power Plus Electrical Contracting, Inc.
Fred Fisher First State Electric Company Matthew Galinskie, AEE Fayda Engineering & Energy Solutions, LLC
Date of Report: September 30, 2026 FE&ES Comm. No.: 25-1643A
Items of Discussion:
1.0 These Pre-Bid Meeting Minutes, Addendum No. 1, shall be made part of the Project Manual and
Drawings dated September 2026 for “HDP Generator & ATS Replacement” at Hazel D. Plant Women’s Treatment Facility, 620 Baylor Blvd., New Castle DE 19720.
2.0 Sealed bids for OMB/DFM Contract No. MC3806000026 – HDP Generator & ATS Replacement, will be received by the State of Delaware, Office of Management and Budget, Division of Facilities Management by way of the Bonfire Portal at https://DFM.bonfirehub.com until 1:00PM local time on October 29, 2026. Bids may also be delivered in person to 122 Martin Luther King Jr BLVD S Dover DE 19901 no later than the date and time indicated above. Bidder bears the risk of late submission.
Bids will be opened and read aloud at 2:00PM local time on October 29, 2026 at the Haslet
Armory, 122 Martin Luther King Jr. Blvd. S., Dover, DE 19901.
3.0 This is a mandatory pre-bid meeting and only Prime Bidders are limited to those in attendance.
Pre-Bid Meeting Minutes & Addendum No. 1 HDP Generator & ATS Replacement Hazel D. Plant Women’s Treatment Facility
4.0 For further bidding information relating to the Project Manual and Drawings, the contractors are directed to contact Matthew Galinskie, AEE at Fayda Engineering & Energy Solutions, LLC at telephone: 302-999-1060. Contractor Requests for Substitution, Clarification or Interpretation shall be delivered electronically (by email) to mgalinskie@faydaees.com, with CC to efayda@faydaees.com. Ensure the project title, contractor’s name and RFI # are in the subject line. (Example: HDP Generator & ATS Replacement “Contractor Name”- RFI #1)
5.0 The wage rates for this Project are Delaware Department of Labor and Division of Industrial Affairs for New Castle County, Heavy Construction Classification, effective 3/15/26. A certified copy of the prevailing wage rates and Debarred list of contractors for this specific project is included in the Project Manual. This approved scale of wages must be posted by the Contractor in a prominent and easily accessible place at the work site.
6.0 Contractors are to contact the Department of Labor if they have any questions with regard to the State Prevailing Wage Law or clarifications on payroll reporting. Telephone number is 302-451- 3423.
7.0 Contractors are reminded that if they are a recognized contractor that customarily performs the work of a given subcontractor classification; that they can list themselves on the line for that particular subcontractor category. DO NOT LEAVE ANY BLANKS ON THE BID FORM. DO NOT ADD
ANY ADDITIONAL VERBIAGE OTHER THAN WHAT IS REQUESTED. FAILURE TO DO SO MAY
DISQUALIFY YOUR BID. As an example, if you are an electrical contractor that will self-perform the electrical work, that you list your company on the Electrical Subcontractor line on the bid form. Ensure your address, business license, etc. is also included on the bid form.
8.0 The prime contractor and all listed subcontractors must have a drug testing program in place.
There is an Affidavit located with the Bid Form.
9.0 Project Summary
A. Project scope: The Hazel D. Plant currently maintains a 150kW diesel driven Emergency
Generator and (2) Automatic Transfer Switches. The generator will be replaced with a Natural Gas unit and integrated into the existing building electrical distribution system.
Both ATS’ will be replaced in kind.
Base Bid: All work shown on the Contract Documents
Alternates: There are no Alternates
Unit Prices: There are no Unit Prices
Allowances:
ALLOWANCE #1: $25,000.00 for “Unforeseen system modifications”.
ALLOWANCE #2: $15,000.00 for “Utility Company Costs”.
Hazel D. Plant Women’s Treatment Facility
10.0 Contractor must be a registered plan holder in order to submit a bid. One complete Bid Form shall be submitted. Only Addendum #1 will be sent out to all attendees of the Pre-bid meeting.
All other addenda will be sent out to the registered plan holders via email. Contractors are encouraged to monitor their email accounts during the Bidding period for such updates.
11.0 Bidders shall verify that their Sub-bidders are in full receipt of the information contained herein.
12.0 A two (2) year warranty is required on work and materials beginning on the date of substantial completion.
13.0 One of the purposes of the pre bid is to establish a list of subcontractors. A revised list is included with the attached Bid Form. They are:
1. Electrical
2. Mechanical
3. Concrete
Any subcontractors used but not specifically named must also be listed as a 3rd tier subcontractor under the listed subcontractor category. The omission of a required 3rd tier subcontractor may render your bid non-responsive. When in doubt, list it.
14.0 In completing the Bid Form, contractors shall identify the # of calendar days to complete the project beginning on the date that their PO is received and completed on the Date of Substantial Completion.
15.0 The following sections of the specifications were reviewed:
Section Article Title ------ Advertisement for Bids 00 21 15 3.3 Instructions to Bidders 00 26 00 ------ Procurement Substitution Procedures & Forms 00 10 00 1.03 Project Summary 00 81 16.1 ------ DOC Security Form #1 00 81 16.2 ------ Security Clearance Application 26 32 13 1.5 Engine Generators
16.0 The drawings were generally reviewed to present the intent of the contract documents.
1. The project must be internally phased due to restrictions that may affect ongoing operations.
2. A proposed phasing plan has been provided; however, since this is a Means & Methods issue, the successful contractor shall provide their own phasing plan. It should not be submitted with your bid.
3. Temporary/Roll Up generators will be required. Duration and quantity are a Means &
Methods issue; however, the shorter the rental, the lower the cost.
Hazel D. Plant Women’s Treatment Facility
17.0 The following items were discussed in detail:
A. Work Restrictions
1. This is a Correctional Facility. Restricted access is required 24/7/365. Work shall only be performed with a DOC escort.
2. Only staff that have submitted and received approval of a background check will be permitted on site. This includes the contractor’s walkthrough and construction.
3. Access to the Facility:
a. Contractors shall check in daily with the DOC provided escort at the exterior of
Facility. In general, access through the main building entrance will not be required.
b. Contractor will be permitted to park company vehicles near the existing generator yard, however, vehicles shall be kept to a minimum due to space restrictions. Contractor vehicles will not be subjected to daily tool inventory or security checks.
c. Proper ID is required at all times by all on site personnel.
d. Cell phones and cameras will be permitted for exterior work only. Use of cell phone or camera within the Facility must be pre-approved during construction.
e. A tool inventory log will not be required at the beginning and end of each work day. Do not leave tools unattended.
4. An exterior lockable job box may be staged at the existing generator location during construction.
5. Equipment may remain on site after working hours provided all equipment is properly locked and secured.
6. Vehicles & other equipment shall not be left unattended and shall be secured at all times. All construction materials & tools must be secured or removed from the site when contractors are not actively working in a designated area (lunch, end of day, etc.)
7. On-Site Work Hours: Working hours will be 7:00 a.m. to 3:00 p.m.; Monday thru Friday. Any shutdowns to existing equipment must be performed after normal working hours, or on weekends, and shall be coordinated and approved by DOC in advance.
B. There is a short window to get your background checks in and approved before the walkthrough. Contractors shall expedite submission of all security clearance forms directly to Jay Hornbeck at Judson.Hornbeck@delaware.gov
Hazel D. Plant Women’s Treatment Facility
C. Substitution Requests: A standard of design is identified in the specifications along with pre-approved equals. Any manufacturer other than the Standard of Design will be required to submit a complete submission for review for acceptance and posting via Addendum. The deadline for substitution requests is 10 days prior to bid opening, or 1:00 PM on Monday, October 19, 2026.
Instructions for requesting substitutions are very specific and are contained in the project manual. If the contractor does not follow the process, it is automatic grounds for rejection.
D. All questions should be directed in writing to the Engineer. Contractors are encouraged to submit questions as soon as possible. All answers to questions not in addendum format will not be binding. In the case of a conflict between the specifications and drawings or within each not answered by addendum, the greater quantity or better quality shall be provided. The deadline for questions shall be or 1:00 PM on Friday, October 23, 2026.
E. Billing for stored material will not be paid unless the material is on the jobsite and in a secure location under the contractor’s control.
F. Contractor shall provide a lockable portable toilet for the duration of on-site construction.
G. The facility is tobacco free. No form of tobacco is permitted on site; including e-cigarettes, vape, etc.
H. Contractor will be responsible for all permits, licenses, required inspections and fees for this project.
I. Contractors are reminded that it will be unlikely that the bid due date will change.
18.0 A site review of the project site is scheduled for 9:00 AM, Thursday, October 8, 2026 for all registered attendees. A maximum of 3 representatives will be permitted for each registered contractor. In order to attend this site review, a background check is required. A copy is included with the pre-bid meeting minutes.
Contact Matt Galinskie at the Engineer’s office at 302-999-1060 to register for the walk-thru. If no one registers, the walk through will be cancelled.
19.0 The successful contractor shall designate one job foreman who will remain as the main point of contact throughout the duration of the project. This foreman must be on-site whenever any sub-contractors are on-site
20.0 Reminder: For your bid to be deemed responsive, you need to include:
1. Bid Form- One (1) Original, no blanks use the latest version published by Addenda.
2. Bid Bond or Certified check in the amount of 10% of your bid.
3. Drug Testing Affidavit for Prime Contractor.
4. Affidavit of Contractor Qualifications.
Hazel D. Plant Women’s Treatment Facility
21.0 Changes to Specifications
21.1 Section 00 41 13 Bid Form: Replace current Bid Form with the one attached that includes subcontractor listing and Allowance #2.
21.2 Section 00 11 16 Invitation to Bid: Replace the first paragraph in its entirety with:
“Sealed bids for OMB/DFM Contract No. MC3806000026 – HDP Generator & ATS
Replacement, will be received by the State of Delaware, Office of Management and Budget, Division of Facilities Management by way of the Bonfire Portal at https://DFM.bonfirehub.com until 1:00PM local time on October 29, 2026. Bids may also be delivered in person to 122 Martin Luther King Jr BLVD S Dover DE 19901 no later than the date and time indicated above. Bidder bears the risk of late submission.”
21.3 Section 01 21 00 Allowances: Add Article 3.03.B in its entirety:
B. Allowance No. 2 – Utility Company Allowance:
1. Under this allowance, include an amount equal to $15,000.00 for Utility
Company Costs. If costs are less than this amount, a credit to the contract will be taken.
22.0 Changes to Drawings
22.1 No changes to Drawings.
23.0 Questions/Clarifications
23.1 No Questions or Clarifications.
Original Signature on File
Matthew Galinskie, AEE MG/mg 25-1643A Addendum #1- Pre-Bid Meeting Minutes #1
Attachments: Sign-in Sheet 00 41 13 Bid Form 00 81 16.2 Security Clearance Application cc: All in Attendance All Registered Plan Holders P-File
Pre-Bid Meeting MInutes-Addendum #1
DELAWARE DEPARTMENT OF CORRECTION HDP GENERATOR & ATS REPLACEMENT
HAZEL D. PLANT WTF OMB/DFM PROJECT #: MC3806000026
BID FORM
HDP GENERATOR & ATS REPLACEMENT
HAZEL D. PLANT WTF
OMB/DFM PROJECT: MC3806000026
FAYDA ENGINEERING & ENERGY SOLUTIONS BID FORM
FE&ES Comm.: 25-1643A 00 41 13-1
For Bids Due: 1:00 PM; Thursday, October 29, 2026 To: Mr. Brian Cotner, Construction Project Manager OMB/Division of Facilities Management Haslet Armory Building 122 Martin Luther King Jr. Blvd-South Dover, DE 19901
Name of Bidder:
Delaware Business License No.: Taxpayer ID No.:
(Other License Nos.):
Phone No.: ( ) - Fax No.: ( ) -
The undersigned, representing that he has read and understands the Bidding Documents and that this bid is made in accordance therewith, that he has visited the site and has familiarized himself with the local conditions under which the Work is to be performed, and that his bid is based upon the materials, systems and equipment described in the Bidding Documents without exception, hereby proposes and agrees to provide all labor, materials, plant, equipment, supplies, transport and other facilities required to execute the work described by the aforesaid documents for the lump sum itemized below:
BASE BID: PROVIDE ALL WORK SHOWN ON THE CONTRACT DOCUMENTS.
Amount: ($ )
ALTERNATES
There are No Alternates
ALLOWANCES:
ALLOWANCE #1: We have included an allowance amount equal to $25,000.00 in the Base Bid for miscellaneous costs not identified on the bid documents. I/We have reviewed and familiarized ourselves with the requirements contained in Specification Section 01 21 00 Allowances.
Acknowledged by: __________________________________________________
ALLOWANCE #2: We have included an allowance amount equal to $15,000.00 in the Base Bid for Utility Company Costs. I/We have reviewed and familiarized ourselves with the requirements contained in Specification Section 01 21 00 Allowances.
Acknowledged by: __________________________________________________
UNIT PRICES:
There are no Unit Prices.
HDP GENERATOR & ATS REPLACEMENT DELAWARE DEPARTMENT OF CORRECTION
OMB/DFM PROJECT #: MC3806000026 HAZEL D. PLANT WTF
BID FORM
HDP GENERATOR & ATS REPLACEMENT
HAZEL D. PLANT WTF
OMB/DFM PROJECT: MC3806000026
BID FORM FAYDA ENGINEERING & ENERGY SOLUTIONS
00 41 13-2 FE&ES Comm.: 25-1643A
I/We acknowledge Addendums numbered and the price(s) submitted include any cost/schedule impact they may have.
This bid shall remain valid and cannot be withdrawn for thirty (30) days from the date of opening of bids (60 days for School Districts and Department of Education), and the undersigned shall abide by the Bid Security forfeiture provisions. Bid Security is attached to this Bid.
The Owner shall have the right to reject any or all bids, and to waive any informality or irregularity in any bid received.
This bid is based upon work being accomplished by the Sub-Contractors named on the list attached to this bid.
Should I/We be awarded this contract, I/We pledge to achieve substantial completion of all the work within calendar days of the Notice to Proceed.
The undersigned represents and warrants that he has complied and shall comply with all requirements of local, state, and national laws;
that no legal requirement has been or shall be violated in making or accepting this bid, in awarding the contract to him or in the prosecution of the work required; that the bid is legal and firm; that he has not, directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken action in restraint of free competitive bidding.
Upon receipt of written notice of the acceptance of this Bid, the Bidder shall, within twenty (20) calendar days, execute the agreement in the required form and deliver the Contract Bonds, and Insurance Certificates, required by the Contract Documents.
I am / We are an Individual / a Partnership / a Corporation
By Trading as (Individual’s / General Partner’s / Corporate Name)
(State of Corporation)
Business Address:
Witness: By:
(Authorized Signature)
(SEAL)
(Title)
Date:
ATTACHMENTS
Sub-Contractor List Non-Collusion Statement
Affidavit of Employee Drug Testing Program Affidavit of Contractor Qualifications
Bid Security (Others as Required by Project Manuals)
Pre-Bid Meeting MInutes-Addendum #1
BID FORM
HDP GENERATOR & ATS REPLACEMENT
HAZEL D. PLANT WTF
OMB/DFM PROJECT: MC3806000026
FAYDA ENGINEERING & ENERGY SOLUTIONS BID FORM
FE&ES Comm.: 25-1643A 00 41 13-3
SUBCONTRACTOR LIST
In accordance with Title 29, Chapter 69, Section 6962(d)(10)b of the Delaware Code, the following subcontractor listing must accompany any bid submittal. The bidder must list in each category the full name and address (City & State) of the sub-contractor that the bidder will be using to perform the work and provide material for that subcontractor category. Should the bidder’s listed subcontractor intend to provide any of their subcontractor category of work through a third-tier contractor, the bidder shall list that third-tier contractor’s full name and address (City & State). If the bidder intends to perform any category of work itself, it must list its full name and address. For clarification, if the bidder intends to perform the work themselves, the bidder may not insert “not applicable”, “N/A”, “self” or anything other than its own full name and address (City & State). To do so shall cause the bid to be rejected. In addition, the failure to produce a completed subcontractor list with the bid submittal shall cause the bid to be rejected. If you have more than three (3) third-tier contractors to report in any subcontractor category, print out additional page(s) containing the appropriate category, complete the rest of your list of third-tier contractors for that category, notate the addition in parentheses as (CONTINUATION) next to the subcontractor category and an asterisk (*) next to any additional third-tier contractors, and submit it with your bid.
Subcontractor Category Subcontractor Address (City & State) Subcontractors tax-payer ID # or Delaware Business license #
1. Electrical
A.
B.
C.
2. Mechanical
A.
B.
C.
Pre-Bid Meeting MInutes-Addendum #1
BID FORM
HDP GENERATOR & ATS REPLACEMENT
HAZEL D. PLANT WTF
OMB/DFM PROJECT: MC3806000026
BID FORM FAYDA ENGINEERING & ENERGY SOLUTIONS
00 41 13-4 FE&ES Comm.: 25-1643A
3. Concrete
A.
B.
C.
Pre-Bid Meeting MInutes-Addendum #1
BID FORM
HDP GENERATOR & ATS REPLACEMENT
HAZEL D. PLANT WTF
OMB/DFM PROJECT: MC3806000026
FAYDA ENGINEERING & ENERGY SOLUTIONS BID FORM
FE&ES Comm.: 25-1643A 00 41 13-5
NON-COLLUSION STATEMENT
This is to certify that the undersigned bidder has neither directly nor indirectly, entered into any agreement, participated in any collusion or otherwise taken any action in restraint of free competitive bidding in connection with this proposal submitted this date (to the Office of Management and Budget, Division of Facilities Management).
All the terms and conditions of (OMB/DFM PROJECT: MC3806000026) have been thoroughly examined and are understood.
NAME OF BIDDER:
AUTHORIZED REPRESENTATIVE
(TYPED):
AUTHORIZED REPRESENTATIVE
(SIGNATURE):
TITLE:
ADDRESS OF BIDDER:
E-MAIL: ______________________________________________________________
PHONE NUMBER:
Sworn to and Subscribed before me this day of 20 .
My Commission expires . NOTARY PUBLIC .
THIS PAGE MUST BE SIGNED AND NOTARIZED FOR YOUR BID TO BE CONSIDERED.
Pre-Bid Meeting MInutes-Addendum #1
BID FORM
HDP GENERATOR & ATS REPLACEMENT
HAZEL D. PLANT WTF
OMB/DFM PROJECT: MC3806000026
BID FORM FAYDA ENGINEERING & ENERGY SOLUTIONS
00 41 13-6 FE&ES Comm.: 25-1643A
AFFIDAVIT
OF
EMPLOYEE DRUG TESTING PROGRAM
4104 Regulations for the Drug Testing of Contractor and Subcontractor Employees Working on Large Public Works Projects requires that Contractors and Subcontractors implement a program of mandatory drug testing for Employees who work on Large Public Works Contracts funded all or in part with public funds.
We hereby certify that we have in place or will implement during the entire term of the contract a Mandatory Drug Testing Program for our employees on the jobsite, including subcontractors, that complies with this regulation:
Contractor/Subcontractor Name:
Contractor/Subcontractor Address:
Authorized Representative (typed or printed):
Authorized Representative (signature):
Title:
Sworn to and Subscribed before me this day of 20 .
My Commission expires . NOTARY PUBLIC .
THIS PAGE MUST BE SIGNED AND NOTARIZED FOR YOUR BID TO BE CONSIDERED.
Pre-Bid Meeting MInutes-Addendum #1
BID FORM
HDP GENERATOR & ATS REPLACEMENT
HAZEL D. PLANT WTF
OMB/DFM PROJECT: MC3806000026
FAYDA ENGINEERING & ENERGY SOLUTIONS BID FORM
FE&ES Comm.: 25-1643A 00 41 13-7
AFFIDAVIT
OF
CONTRACTOR QUALIFICATIONS
We hereby certify that we will abide by the contractor’s qualifications outlined in the construction bid specifications for the duration of the contract term.
In accordance with Title 29, Chapter 69, Section 6962(d)(10)b.3 of the Delaware Code, after a contract has been awarded the successful bidder shall not substitute another subcontractor whose name was submitted on the Subcontractor Form except for the reasons in the statute and not without written consent from the awarding agency. Failure to utilize the subcontractors on the list will subject the successful bidder to penalties as outlined in the General Requirements Section 5.2 of the contract.
Contractor Name:
Contractor Address:
Authorized Representative (typed or printed):
Authorized Representative (signature):
Title:
Sworn to and Subscribed before me this day of 20 .
My Commission expires . NOTARY PUBLIC .
THIS PAGE MUST BE SIGNED AND NOTARIZED FOR YOUR BID TO BE CONSIDERED.
Pre-Bid Meeting MInutes-Addendum #1
| 25-1643A Addendum #1- Pre-Bid Meeting Minutes #1 |
| Sign-in Sheet |
| SKM_454e26093009440 |
| SKM_454e26093009450 |
| 00 41 13 Bid Form-8.28.20-1 |
| 00 81 16.2 Security Clearance Application DOC 2021 |
| Last Name: |
| First Name: |
| Middle Name: |
| All Other Names Used: |
| DOB: |
| PLACE OF BIRTH: |
| Social Security Number: |
| SEX MALE I FEMALE RACE: |
| DRIVERS LICENSE: |
| STATE: |
| ADDRESS: |
| APT: |
| CITY: |
| STATE_2: |
| ZIP: |
| PHONE HOME: |
| WORK: |
| undefined: |
| EMAIL: |
| PLEASE LIST WHICH FACILITYIES YOU ARE REQUESTING ACCESS TO 1: |
| PLEASE LIST WHICH FACILITYIES YOU ARE REQUESTING ACCESS TO 2: |
| PLEASE LIST WHICH FACILITYIES YOU ARE REQUESTING ACCESS TO 3: |
| PLEASE LIST WHICH FACILITYIES YOU ARE REQUESTING ACCESS TO 4: |
| Offender Visit: Off |
| One Time Access: Off |
| Occasional Volunteer: Off |
| Frequent/LongTerm Volunteer: Off |
| COUNTRY: |
| DATE: |
| OFFENSE: |
| COUNTRY_2: |
| DATE_2: |
| OFFENSE_2: |
| SENTENCE: |
| ARE YOU PRESENTLY UNDER DEPT of CORRECTION SUPERVISION NOYES IF YES WHAT: |
| IF YES NAME OF INMATE AND YOUR RELATIONSHIP TO THEM: |
| REASONFORCLEARANCE: |
| DATES OF ACTIVITY: |
| ORGANIZATION: |
| PROGRAM NAME: |
| JOB TITLE: |
| HOW LONG EMPLOYEDNOLUNTEERING: |
| ORGANIZATION ADDRESS PHONE NUMBER AND EMAIL 1: |
| ORGANIZATION ADDRESS PHONE NUMBER AND EMAIL 2: |
| ORGANIZATION ADDRESS PHONE NUMBER AND EMAIL 3: |
| WHAT TYPE OF VOLUNTEER OR PROFESSIONAL SERVICES WILL YOU BE PROVIDING 1: |
| WHAT TYPE OF VOLUNTEER OR PROFESSIONAL SERVICES WILL YOU BE PROVIDING 2: |
| WHAT TYPE OF VOLUNTEER OR PROFESSIONAL SERVICES WILL YOU BE PROVIDING 3: |
| DESCRIBE YOUR QUALIFICATIONS FOR PROVIDING PROFESSIONAL OR VOLUNTEER SERVICES 1: |
| DESCRIBE YOUR QUALIFICATIONS FOR PROVIDING PROFESSIONAL OR VOLUNTEER SERVICES 2: |
| DESCRIBE YOUR QUALIFICATIONS FOR PROVIDING PROFESSIONAL OR VOLUNTEER SERVICES 3: |
| DESCRIBE YOUR QUALIFICATIONS FOR PROVIDING PROFESSIONAL OR VOLUNTEER SERVICES 4: |
| INCLUDE NAME LENGTH OF SERVICE CONTACT PERSON AND PHONE NUMBER OR EMAIL 1: |
| INCLUDE NAME LENGTH OF SERVICE CONTACT PERSON AND PHONE NUMBER OR EMAIL 2: |
| INCLUDE NAME LENGTH OF SERVICE CONTACT PERSON AND PHONE NUMBER OR EMAIL 3: |
| INCLUDE NAME LENGTH OF SERVICE CONTACT PERSON AND PHONE NUMBER OR EMAIL 4: |
| DATE_3: |
| SIGNATURE 2: |
| DELA WARE WANTSW ARRANTS: |
| DELWARE CRIMINAL HISTORY: |
| NCIC WANTSWARRANTS: |
| NCIC CRIMINAL HISTORY: |
| INVESTIGATOR: |
| DATE_4: |
| APPROVtm: |
| APPROVAL EXPIRES ON: |
| DENIED: |
| DATE_5: |
| Date: |
| Printed Name: |
| Org/Company: |
| Program Name: |
File details come from the government source that posted it. Updated .