2.2.1 Attachment 7_SF_91_Motor Vehicle Accident Report - CONUS.pdf
PDF 752 KB Posted
- Attached to
- CONUS Generator Maintenance Services Federal contract opportunity
- Solicitation number
- 70FB7022R00000008
- Issued by
- Federal Emergency Management Agency
About this file
This solicitation is for on-site generator maintenance services for the Federal Emergency Management Agency's CONUS generator fleet. Services include annual maintenance, quarterly maintenance, return to storage, and repairs performed on a firm fixed price basis for up to five years. Responses are due by August 19, 2022 to Solicitation Number 70FB7022R00000008. This is a small business set-aside with a NAICS code of 811310 and PSC of J030. The solicitation and amendments will be posted to SAM.gov, and offerors must monitor the site and download documents as no hard copies will be provided.
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Text version
CONUS Generator Maintenance Attachment 7 - SF91 - Motor Vehicle Accident
RFP: 70FB7022R00000008 March 2022
| 1_DRIVERS_NAME_Last_first: |
| 2_DRIVERS_LICENSE_NOSTATE: |
| 3_DATE_OF_ACCIDENT: |
| 4a_DEPARTMENTFEDERAL_AGEN: |
| Comb1: |
| Comb11: |
| 5_TAG_OR_IDENTIFICATION_N: |
| FillText6: |
| 7_YEAR_OF_VEHICLE: |
| 8_MAKE: |
| 9_MODEL: |
| 10_SEAT_BELTS_USED: Off |
| 1_1_DESCRIBE_VEHICLE_DAMA: |
| 12_DRIVERS_NAME_Last_firs: |
| 13_DRIVERS_LICENSE_NUMBER: |
| 14a_DRIVERS_WORK_ADDRESS: |
| Comb2: |
| Comb21: |
| 15a_DRIVERS_HOME_ADDRESS: |
| Comb3: |
| Comb31: |
| 16_DESCRIBE_VEHICLE_DAMAG: |
| FillText7: |
| 18_YEAR_OF_VEHICLE: |
| 19_MAKE_OF_VEHICLE: |
| 20_MODEL_OF_VEHICLE: |
| 21_TAG_NUMBER_AND_STATE: |
| 22a_DRIVERS_INSURANCE_COM: |
| 22b_POLICY_NUMBER: |
| Comb4: |
| Comb41: |
| COOWNED: Off |
| LEASED: Off |
| RENTAL: Off |
| PRIVATELY_OWNED: Off |
| 24a_OWNERS_NAMES_Last_fir: |
| Comb5: |
| Comb51: |
| SECTION_III__KILLED_OR_IN: |
| 26_NAME_Last_first_middle: |
| 27_SEX: |
| 28_DATE_OF_BIRTH: |
| 29_ADDRESS: |
| KILLED1: Off |
| INJURED1: Off |
| DRIVER1: Off |
| HELPER1: Off |
| PASSENGER1: Off |
| PEDESTRIAN1: Off |
| FED1: Off |
| OTHER_2: Off |
| 32_LOCATION_IN_VEHICLE: |
| 33_FIRST_AID_GIVEN_BY: |
| 34_TRANSPORTED_BY: |
| 35_TRANSPORTED_TO: |
| 36_NAME_Last_first_middle: |
| 37_SEX: |
| 38_DATE_OF_BIRTH: |
| 39_ADDRESS: |
| KILLED2: Off |
| INJURED2: Off |
| DRIVER2: Off |
| HELPER2: Off |
| PASSENGER2: Off |
| PEDESTRIAN2: Off |
| FED2: Off |
| OTHER_1: Off |
| 42_LOCATION_IN_VEHICLE: |
| 43_FIRST_AID_GIVEN_BY: |
| 44_TRANSPORTED_BY: |
| 45_TRANSPORTED_TO: |
| a_NAME_OF_STREET_OR_HIGHW: |
| FROM: |
| TO: |
| c_DESCRIBE_WHAT_PEDESTRIA: |
| 47_DATE_OF_ACCIDENT: |
| 48_PLACE_OF_ACCIDENT_Stre: |
| FillText8: |
| FillText9: |
| FED3: |
| FED4: |
| FED5: |
| FED6: |
| FED7: |
| FED8: |
| FED9: |
| FED10: |
| 1: |
| 3: |
| 4: |
| 5: |
| 6: |
| 7: |
| 8: |
| 9: |
| SECTION_V__WITNESSPASSENG: |
| 53_NAME_Last_first_middle: |
| Comb7: |
| Comb71: |
| Comb8: |
| Comb81: |
| 56_BUSINESS_ADDRESS: |
| 57_HOME_ADDRESS: |
| 58_NAME_Last_first_middle: |
| Comb9: |
| Comb91: |
| Comb10: |
| Comb101: |
| 61_BUSINESS_ADDRESS: |
| 62_HOME_ADDRESS: |
| 63a_NAME_OF_OWNER: |
| Comb111: |
| Comb6: |
| Comb12: |
| Comb121: |
| 63d_BUSINESS_ADDRESS: |
| 63e_HOME_ADDRESS: |
| 64a_NAME_OF_INSURANCE_COM: |
| Comb13: |
| Comb131: |
| 64c_POLICY_NUMBER: |
| 65_ITEM_DAMAGED: |
| 66_LOCATION_OF_DAMAGED_IT: |
| 67_ESTIMATED_COST: |
| 68a_NAME_OF_POLICE_OFFICE: |
| 68b_BADGE_NUMBER: |
| Comb14: |
| Comb141: |
| 69_PRECINCT_OR_HEADQUARTE: |
| 70a_PERSON_CHARGED_WITH_A: |
| 70b_VIOLATIONS: |
| SECTION_IX__FEDERAL_DRIVE: |
| 71_a_NAME_AND_TITLE_OF_DR: |
| 72_ORIGIN: |
| 73_DESTINATION: |
| FillText10: |
| DATE1: |
| FillText11: |
| FillText12: |
| DATE2: |
| FillText13: |
| FillText14: |
| ORALLY: Off |
| IN_WRITING_Explain: Off |
| FillText15: |
| 78_WAS_THERE_ANY_DEVIATIO: Off |
| FillText16: |
| 79_WAS_THE_TRIP_MADE_WITH: Off |
| FillText17: |
| 80_DID_THE_OPERATOR_WHILE: Off |
| FillText18: |
| a_DID_THIS_ACCIDENT_OCCU1: Off |
| b_COMMENTS: |
| 82a_NAME_AND_TITLE_OF_SUP: |
| 71b_DRIVER_DATE: |
| Comb15: |
| Comb151: |
| SECTION_XI__ACCIDENT_INVE: Off |
| 84_PERSONS_INTERVIEWED: |
| a_b: |
| DATE3: |
| FillText20: |
| FillText21: |
| d_C: |
| DATE4: |
| FillText19: |
| FillText22: |
| SECTION_XII__ATTACHMENTS: |
| SECTION_XIII__COMMENTSAPP: |
| FillText23: |
| 82b_SUPERVISOR_DATE: |
| b_NAME_First_middle_last: |
| c_TITLE: |
| d_OFFICE: |
| Comb16: |
| Comb161: |
| 87a_date: |
| 88a_date: |
| b_NAME_First_middle_last1: |
| c_TITLE1: |
| d_OFFICE1: |
| Comb17: |
| Comb171: |
File details come from the government source that posted it. Updated .