Trip Request Form.pdf
PDF 272 KB Posted
- Attached to
- Air Charter Flight for Medical Transportation
- Solicitation number
- 15B61827Q00000004
About this file
This is an Air Charter/Air Ambulance Trip Quotation Form used by the Bureau of Prisons (BOP) to solicit pricing from vendors for inmate transportation services.
The form is divided into two sections: one completed by BOP institution staff and one completed by vendors. The BOP section captures the requesting institution (USP Atwater, Atwater, California), ordering official contact information, service type selection (Air Charter or Air Ambulance), detailed itinerary with departure and arrival airports and times, security and medical staff details, number of inmates (2 in the example), and special requirements (wheelchair accessibility). The itinerary specified includes Castle Airport (KMER) as the initial departure point on 11/19/2026 at 6:00 AM, with intermediate stops at Pullman-Moscow (PUW) and final arrival at Rochester International Airport (RST). The form also requires an after-hours emergency contact number for flight changes or delays.
The vendor section requires completion of aircraft details (type and tail number), pilot and crew names, departure and arrival dates with estimated times, calculation of total cost based on air nautical miles at a specified price per nautical mile (using Great Circle Distance methodology), and itemization of additional costs such as airport fees, fuel adjustments, federal transportation taxes, and catering fees. Vendors must provide a total trip cost and sign the quotation with name, title, and date. This form serves as the quotation mechanism for BOP to obtain competitive pricing for ad hoc air transportation services for inmates requiring specialized movement.
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| File | Type | Posted |
|---|---|---|
| RFQ 15B61827Q00000004.pdf |
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Text version
Air Charter/Air Ambulance Trip Quotation Form
(SECTION TO BE COMPLETED BY BOP INSTITUTION STAFF)
Requesting Institution and Address: ________________________________________________
Name of Ordering Official: ________________________________________________
Phone and Fax Number: ________________________________________________
Email: ________________________________________________
Type of Service (Circle One): Air Charter Air Ambulance
Itinerary
Date Time Airport
Depart
Arrive
Depart
Arrive
Depart
Arrive
BOP Security Staff: __________________________________________________________________ (Include Name and Title)
BOP Medical Staff: __________________________________________________________________ (Include Name and Title)
Number of Inmates: __________________________
Special Instructions (Wheelchair, Oxygen, Ventilator, IV, etc): ______________________________________
In case of flight changes or delays, please include an after-hours emergency contact name and phone number:
Name, Title and Signature of Ordering Official
USP Atwater 1 Federal Way Atwater Ca, 95301
Ashlie Ybarra
209-386-4791 aybarra@bop.gov
11/19/2026 6am Castle Airport: KMER
11/19/2026 Pullman-Moscow: PUW
11/19/2026 Pullman-Moscow: PUW
11/19/2026 Rochester International Airport: RST
Rochester Internatonal Airport:RST
Castle Airport: KMER
A. Verna Lieutenant, C. Lanning Officer, T. Vang Officer
None both inmates require wheelchairs
Ashlie Ybarra: 209-349-2825
ASHLIE YBARRA Digitally signed by ASHLIE YBARRA Date: 2026.11.09 17:54:18 -08'00'
(SECTION TO BE COMPLETED BY EACH VENDOR)
___________________________________________________________Vendor Name and POC:
Name of Charter Company (if used): ___________________________________________________________
Type of Aircraft: ______________________________ Tail Number: _________________________________
Name of Pilot: ______________________________ Name of Co-Pilot: ____________________________________
Names of Other Crew Members/Medical Staff: ___________________________________________________________
Departure Date and Estimated Time: _____________________________________________
Arrival Date and Estimated Time: _____________________________________________
Total Number of Air Nautical Miles: ___________ X $________Price Per Air = $_______________ (Based on Great Circle Distance) Nautical Mile
Additional Costs (i.e., Airport Fees, Fuel Adjustment, Federal Transportation Tax, Catering Fees, etc.)
(Please List Separately)
TOTAL COST OF TRIP: $_______________________________________
_ Name, Title, and Signature of Vendor Date
File details come from the government source that posted it. Updated .