Affirmation and Disclosure Form.pdfAffirmation and Disclosure Form.pdf

This Affirmation and Disclosure Form is associated with a local ambulance services contract opportunity issued by the Ohio Department of Rehabilitation and Correction (ODRC) for Southeastern Correctional Institution. The contract requires the selected vendor to provide emergency and non-emergency medical transportation for inmates, with a mandatory response time of fifteen minutes or less from initial dispatch call to unit arrival at the location. Services include all emergency and non-emergency trips to local hospitals as well as trips to The Ohio State University Medical Center or Corrections Medical Center, encompassing all disposables and both basic life support (BLS) and advanced life support (ALS) services. The contractor must ensure continuous availability and, should they be unable to meet response time requirements, must arrange alternative ambulance services and reimburse the institution accordingly.

The pricing structure requires the contractor to submit separate fee schedules for BLS and ALS services for both local hospital transports and transports to The Ohio State University Medical Center or Corrections Medical Center. The contract is contingent on the contractor's ability to guarantee compliance with the fifteen-minute response time requirement and to absorb costs associated with any third-party ambulance services utilized when the contractor cannot fulfill the obligation. The institution will not reimburse external ambulance services; the contractor assumes full financial responsibility for ensuring adequate service delivery or paying for alternative providers. No additional details regarding contract term, renewal options, incumbents, or specific funding amounts are specified in this affirmation and disclosure form.