Ambulance Services CONTRACTOR CAPABILITY SURVEY ROBINS AFB AW.docx

CONTRACTOR CAPABILITY SURVEY

Service Agreement for Ambulance Services, Robins AFB, GA

Part I. Business Information Please provide the following business information for your company/institution and for any teaming or joint venture partners:

· Company/Institute Name:

· Address:

· Point of Contact:

· CAGE Code:

· Phone Number:

· E-mail Address:

· Web Page URL:

· Size of business pursuant to North American Industry Classification System (NAICS) Code: 621910 (Small Business Size Standard $15M20M)

Based on the above NAICS Code, state whether your company is:

· A statement as to whether your company is domestically or foreign owned (if foreign, please indicate the country of ownership).

Email responses only please, must be received no later than 5PM ET, 3 OCTOBER 2022. Please electronically submit your response by email to the following Points of Contact (POC):

AFSC/PZIOB

Attn: Alex Weichold Alex.Weichold@us.af.mil

Adriana Lytle adriana.lytle@us.af.mil

NOTE: Ensure data is in a readable electronic format. Ensure electronic data can be received through a firewall.

Part II. Capability Survey Questions A. General Capability Questions:

1. Describe briefly the capabilities of your facility and nature of the goods and/or services you provide. Include a description of your staff composition and management structure.

2. Describe your company's past experience on previous projects similar in complexity to this requirement. Include contract numbers, a brief description of the work performed, period of performance, agency/organization supported, and individual point of contact (Contracting Officer or Program Manager).

B. Services Questions

1. Describe your services capabilities and experience regarding the requirements of this effort.

Describe your services capabilities and experience providing all labor, management, supervision, vehicles, supplies, equipment, transportation, and reports (except as provided in Section 3, see attached Performance Work Statement), government furnished property and services for 24-hour a day Paramedic emergency ambulance services for patient transport from all of Robins AFB (RAFB), GA. Contractor shall provide two (2) fully equipped ambulances with personnel on base. Their responsibilities include: (1) emergency Paramedic response and patient transport, (2) in-flight emergency response, (3) participation in RAFB and Military Treatment Facility exercises, and (4) provide third party collections forms (DD Form 2569). Contractor care shall be commensurate to Emergency Medical Technician (EMT), Paramedic and ambulance services provided in the local community. Performance shall be according to the requirements contained in PWS, and professional standards of The Joint Commission, AFI 44-119 Medical Quality Operations, the Department of Transportation and the National Registry for Emergency Medical Technicians (NREMT). The contractor shall participate in flight-line hazard and mishap response planning. These services will be paid for by the government, the contractor shall not bill patients. Service location and customer is 78th MDG, RAFB, GA.