Vendor_Conference_Registration_Form.pdf

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Attached to
Jail Resident Communication Services (Phone, Tablet, Visitation & Mail Scanning)
Solicitation number
2025-RFP-019
Issued by
Dane County, Wisconsin

About this file

This document is a Site Visit - Temporary 1 Day Access/Registration Form for the Dane County Purchasing Department, specifically related to RFP# 2025-RFP-019 for a Vendor Conference. The form is required to be completed and submitted to Megan Rogan (rogan.megan@danecounty.gov) no later than Monday, January 27th, 2025, to gain approval for attending the site visit. The form is part of a comprehensive background check process that requires 3-4 full business days to complete, with potential attendees required to provide detailed personal information including driver's license details, criminal history, and contact information.

The registration form is designed to conduct a thorough background screening for vendors interested in participating in a site visit related to a Jail Resident Communication Services contract. The form includes sections for personal identification, criminal history disclosure, and requires individuals to disclose felony and misdemeanor convictions. The document indicates a rigorous vetting process with multiple background check components including D.O.T. open tickets, C.I.B. jail records, F.B.I. local computer contacts, CCAP records, and warrant checks. The form will be processed by the Project & Program Assistant and reviewed by a Sergeant, suggesting a high level of security and access control for the vendor conference.

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SITE VISIT - TEMPORARY 1 DAY ACCESS/REGISTRATION FORM

Complete this form in its entirety and email to Megan Rogan in the Purchasing Department no later than Monday, January 27th, 2025 in order to be approved to attend the site visit.

rogan.megan@danecounty.gov

Today's Date Date of Access Company Name Position

Reason for Visit RFP# 2025-RFP-019 Vendor Conference Phone #

FIRST name Drivers License # MIDDLE Name State Issued LAST name

Current Address Other LAST names used

Date of Birth

States lived in, past 10 years Sex

Race

Felony Convictions? YES or NO If Yes, when?

Misdemeanor Convictions? YES or NO If Yes, when?

Representative's Signature

Printed Name

PLEASE ALLOW 3-4 FULL BUSINESS DAYS FOR THE BACKGROUND PROCESS TO BE COMPLETED.

THANK YOU.

OFFICE USE ONLY

D.O.T. OPEN TICKETS

C.I.B. JAIL RECORDS

F.B.I. LOCAL COMPUTER CONTACTS

CCAP

WARRANTS

Date Criminal History Run ___________

Project & Program Assistant: B. Xiong _____________________________ Sergeant: ___________________________

OFFICE USE ONLY

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