ATCH 1 - PRICE LIST.doc

REQUEST FOR QUOTATION (RFQ) HTC71122QR010

ATTACHMENT 1

PRICE LIST

1 AIR TRANSPORTATION. Air ambulance services from Outside the United States (OCONUS) to the Continental United States (CONUS) and within CONUS for the movement of Department of Defense (DoD) eligible patients using contractor-furnished aircraft configured to air ambulance standards. Special requirements may be offered on a case-by-case basis. In the future, service areas may be expanded to include within OCONUS Geographic Combatant Commands (GCCs). The Area of Responsibilities (AORs) are defined at the following website: https://www.defense.gov/About/combatant-commands/.

Unit price includes all costs associated with each Great Circle Statute Mile (GCSM) flown, excluding prices for patient care provided by medical personnel below. The unit price shall not include fuel costs. Fuel costs will be reimbursed in accordance with Blanket Purchase Agreement (BPA) Attachment 3, Additional Solicitation Information, paragraph 3.i.

NOTE 1: The Government’s obligation for payment of the positioning leg miles shall be for actual miles flown, but it shall not exceed the mileage between the contractor’s primary operations location and the patient’s embarkation point. For “Round Trip” missions, the Government’s obligation for payment of depositioning leg miles shall be for actual miles flown, not exceeding the mileage between the patient’s debarkation point and the contractor’s primary operations location. Depositioning leg miles will not be paid for “Point-to-Point” missions.

NOTE 2: The total miles flown is provided by the contractor following the mission but shall not deviate more than 5% from the miles calculated from the Great Circle Mapper website (http://gc.kls2.com/)

Round-Trip Point-to-Point

Jet Aircraft

$_________ per GCSM

$_________ per GCSM

Turbo-Prop

$_________ per GCSM

Rotary-Wing

$_________ per GCSM

2 MEDICAL PERSONNEL. Unit prices for medical personnel shall be paid for all hours flown in support of an awarded mission, beginning when the positioning leg miles start, and concluding immediately when the depositioning leg ends. ACM stands for Aeromedical Crew Member.

Level One (ACM-1) Crew Member

$_________ per HOUR

Level Two (ACM-2) Crew Member

Level Three (ACM-3) Crew Member

Level Four (ACM-4) Crew Member

Respiratory Therapist

3 NEONATAL INCUBATOR. Price for neonatal incubator medical equipment in support of an awarded mission from time of award to end of mission (when ordered by the Government).

Neonatal Incubator

$_________ per Mission 4 REIMBURSABLE EXPENSES. Reimbursable expenses include (if applicable): Cancellation Costs, Landing/ Parking/Airport Fees, International Fees, Federal Transportation Tax, and Food and Lodging (if required to remain overnight). Additional mission-related reimbursable expenses may be added to this price list by an attachment. All invoices for reimbursable expenses must be accompanied by paid receipts.

5 FUEL REIMBURSEMENT. Burn rates shall be consistent with the rates identified in the BPA. Separate calculations for different burn rates are required for every aircraft used.

SIGNATURE DATE

TYPED NAME AND TITLE

COMPANY NAME AND ADDRESS

PHONE

E-MAIL ADDRESS