Attach 2b CDRL FA8501-23-Q-0002.pdf
PDF 1 MB Posted
- Attached to
- Ambulance Services, Robins AFB, GA Federal contract opportunity
- Solicitation number
- FA8501-23-Q-0002
About this file
This is a combined synopsis and solicitation from the Department of the Air Force Materiel Command seeking quotes for ambulance services at Robins Air Force Base in Georgia. The solicitation requests quotes to provide 24-hour paramedic ambulance services including vehicles, equipment, supplies, labor, management, transportation, and reporting. Quotes are due by February 16, 2023. The period of performance is from April 1, 2023 to March 31, 2024. The requirement is set aside for small businesses with a NAICS code of 621910 and size standard of $22.5 million. Award will be made to the responsible offeror with the lowest price technically acceptable quote. The contractor must comply with all terms, certifications, and technical requirements specified in attachments including the performance work statement, contract data requirements list, wage determinations, government furnished property listing, and pricing instructions.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment 8 Q and A REV 1.xlsx | XLSX spreadsheet | |
| Attach 1 SF1449 Synopsis_Solicitation FA8501-23-Q-0002_REV1.docx | DOCX document | |
| Attach 8 Q and A.xlsx | XLSX spreadsheet | |
| Attach 1 SF1449 Synopsis_Solicitation FA8501.docx | DOCX document | |
| Attach 2a PWS FA8501-23-Q-0002.pdf | ||
| Attach 3 WD 2015-4495 REV 21 FA8501-23-Q-0002.pdf | ||
| Attach 5 - Pricing Table FA8501-23-Q-0002.xlsx | XLSX spreadsheet | |
| Attach 6 Instructions to Offerors.docx | DOCX document | |
| Attach 7 Evaluation of Offerors.docx | DOCX document | |
| Attach 4 GFP Listing FA8501-23-Q-0002.pdf |
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Ambulance Services Robins AFB, GA
FA8501-23-Q-0002
Contract Data Requirements Listing (CDRL)
Table of Contents (TOC)
1. A001 Safety - Health Plan
2. A002 Mishap /Incident Reports
3. A003 Mission Essential Plan
4. A004 Status Report
5. A005 Quality Control Plan
6. A006 Ambulance Operation Service
License
7. A007 Third Party Collection Run Sheet
8. A008 Inventory
9. A009 Self-Assessment Program
Attachment 2
G. PREPARED BY
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
C. CATEGORY:
TDP ________ TM _______ OTHER _________________________
Form Approved OMB No. 0704-0188
15. TOTAL
PREVIOUS EDITION MAY BE USED.DD FORM 1423-1, AUG 96 (EG) Page ____ of ____ Pages
A. CONTRACT LINE ITEM NO. B. EXHIBIT
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 3. SUBTITLE
6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
H. DATE J. DATEI. APPROVED BY
The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please DO NOT RETURN your form to the above address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.
Designed using Perform Pro, WHS/DIOR, Aug 96
Ambulance Services Contract
F3Q4CA2294AH01
A001
2. TITLE OF DATA ITEM
Safety and Health Plan
5. CONTRACT REFERENCE
PWS PARA 4.8.1 MDSS/SGSM
N/A IAW Contract Prior of contract
16. REMARKS
Block 7: Inspection-Destination Acceptance- Destination
Block 9: Distribution authorized to Department of Defense (DoD) and DoD Contractors for administrative or operation use determined 23 July 1991. Other request for a copy of the document shall be referred to the block 6, requiring office, on the DD Form 1423 that governs the submittal.
Blocks 10, 11, 12, 13, and 14: Submittal is required as requested by MDSS/SGSM, ____________________________________, email: ________________________________
Safety plan will be submitted to __________________________________________ and then forwarded to Safety Office for approval.
1 Copy of deliverable shall be submitted in digital format. An electronic version of all reports shall be prepared using DoD standard automation software, such as the Microsoft Office Suite (to include excel and word) for test.
Contractors shall provide a safety and health plan in compliance with applicable federal, state, local, and consensus standards
MDSS/SGSM 1
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT-51580/T
DD FORM 1423-1, AUG 96
FOR THE CONTRACTOR
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor’s performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data. These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government’s right to use the data shall be governed by the pertinent provisions of the contract.
INSTRUCTIONS FOR COMPLETING DD FORM 1423
(See DoD 5010.12-M for detailed instructions.)
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4;
Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.
(1 Data Item)
C. CATEGORY:
TDP ________ TM _______ OTHER _________________________
Form Approved OMB No. 0704-0188
15. TOTAL
PREVIOUS EDITION MAY BE USED.DD FORM 1423-1, AUG 96 (EG) Page ____ of ____ Pages
A. CONTRACT LINE ITEM NO. B. EXHIBIT
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 3. SUBTITLE
6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
H. DATE J. DATEI. APPROVED BY
The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please DO NOT RETURN your form to the above address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.
Designed using Perform Pro, WHS/DIOR, Aug 96
Ambulance Services Contract
F3Q4CA2294AH01
A002
2. TITLE OF DATA ITEM
Mishap / Incident Report
5. CONTRACT REFERENCE
PWS PARA 4.8.2 78 ABW/SE
N/A IAW Contract Prior of contract
16. REMARKS
1 Copy of deliverable shall be submitted in digital format.
Addressee: WR-ALC/SE Gov't Safety Office 78abw.se.contracts.aprs@us.af.mil
AFSC/PZIOB 1
4. AUTHORITY (Data Acquisition Document No.)
DI-SAFT-81563/T
1 0 0
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor’s performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data. These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government’s right to use the data shall be governed by the pertinent provisions of the contract.
INSTRUCTIONS FOR COMPLETING DD FORM 1423
(See DoD 5010.12-M for detailed instructions.)
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4;
Clarification of submittal dates in Items 12 and 13; Explanation of
(1 Data Item)
C. CATEGORY:
TDP ________ TM _______ OTHER _________________________
Form Approved OMB No. 0704-0188
15. TOTAL
PREVIOUS EDITION MAY BE USED.DD FORM 1423-1, AUG 96 (EG) Page ____ of ____ Pages
A. CONTRACT LINE ITEM NO. B. EXHIBIT
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 3. SUBTITLE
6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE 13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
H. DATE J. DATEI. APPROVED BY
The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please DO NOT RETURN your form to the above address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.
Designed using Perform Pro, WHS/DIOR, Aug 96
Ambulance Services Contract
F3Q4CA2294AH01
A003
2. TITLE OF DATA ITEM
Mission Essential Plan
5. CONTRACT REFERENCE
PWS PARA 4.10.1, 4.10.1.1, 4.10.2 78 AMDS/SGPF
N/A One time
12. DATE OF FIRST SUBMISSION
See remarks
See remarks
16. REMARKS
Block 7: Inspection-Destination Acceptance- Destination
Blocks 10, 11, 12, 13, and 14: Submittal is required as requested by 78 AMDS/
SGPF__________________
Mission Essential Plan will be submitted to __________________
Email Address: ____________________
1 Copy of deliverable shall be submitted in digital format.
AFSC/PZIOB 1
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT-51583/T
1 0 0
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor’s performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data. These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government’s right to use the data shall be governed by the pertinent provisions of the contract.
INSTRUCTIONS FOR COMPLETING DD FORM 1423
(See DoD 5010.12-M for detailed instructions.)
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4;
Clarification of submittal dates in Items 12 and 13; Explanation of
(1 Data Item)
16. REMARKS
C. CATEGORY:
TDP ________ TM _______ OTHER _________________________
Form Approved OMB No. 0704-0188
15. TOTAL
PREVIOUS EDITION MAY BE USED.DD FORM 1423-1, AUG 96 (EG) Page ____ of ____ Pages
A. CONTRACT LINE ITEM NO. B. EXHIBIT
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 3. SUBTITLE
6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
H. DATE J. DATEI. APPROVED BY
The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please DO NOT RETURN your form to the above address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.
Designed using Perform Pro, WHS/DIOR, Aug 96
Ambulance Services Contract
F3Q4CA2294AH01
A004
2. TITLE OF DATA ITEM
Status Report
5. CONTRACT REFERENCE
PWS PARA 4.11 MDSS/SGSM
N/A IAW Contract Prior of contract
Block 7: Inspection-Destination Acceptance- Destination
Block 9: Distribution authorized to Department of Defense (DoD) and DoD Contractors for administrative or operation use determined 23 July 1991. Other request for a copy of the document shall be referred to the block 6, requiring office, on the DD Form 1423 that governs the submittal.
Blocks 10, 11, 12, 13, and 14: Submittal is required as requested by MDSS/SGSM, ____________________________________, email: ________________________________
Safety plan will be submitted to __________________________________________ and then forwarded to Safety Office for approval.
1 Copy of deliverable shall be submitted in digital format. An electronic version of all reports shall be prepared using DoD standard automation software, such as the Microsoft Office Suite (to include excel and word) for test.
Contractors shall provide a safety and health plan to address in detail the items listed in part II through part IV of Appendix C.
MDSS/SGSM 1
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT-51584/T
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor’s performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data. These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government’s right to use the data shall be governed by the pertinent provisions of the contract.
INSTRUCTIONS FOR COMPLETING DD FORM 1423
(See DoD 5010.12-M for detailed instructions.)
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4;
Clarification of submittal dates in Items 12 and 13; Explanation of
(1 Data Item)
16. REMARKS
C. CATEGORY:
TDP ________ TM _______ OTHER _________________________
Form Approved OMB No. 0704-0188
15. TOTAL
PREVIOUS EDITION MAY BE USED.DD FORM 1423-1, AUG 96 (EG) Page ____ of ____ Pages
A. CONTRACT LINE ITEM NO. B. EXHIBIT
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
H. DATE J. DATEI. APPROVED BY
The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please DO NOT RETURN your form to the above address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.
Designed using Perform Pro, WHS/DIOR, Aug 96
Ambulance Services Contract F3Q4CA2294AH01
X
N/AA005 Quality Control Plan
HCOS/SGSM
N/A IAW Contract As required of contract
HCOS/SGSM
Daniel Garcia Flores / COR
Block 7: Inspection-Destination Acceptance- Destination
1 Copy of deliverable shall be submitted in digital format.
9 Nov 2022
DI-MGMT-51580/T PARA 4.5
0 1 0
As required
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor’s performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data. These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government’s right to use the data shall be governed by the pertinent provisions of the contract.
INSTRUCTIONS FOR COMPLETING DD FORM 1423
(See DoD 5010.12-M for detailed instructions.)
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4;
Clarification of submittal dates in Items 12 and 13; Explanation of
(1 Data Item)
C. CATEGORY:
TDP ________ TM _______ OTHER _________________________
Form Approved OMB No. 0704-0188
15. TOTAL
PREVIOUS EDITION MAY BE USED.DD FORM 1423-1, AUG 96 (EG) Page ____ of ____ Pages
A. CONTRACT LINE ITEM NO. B. EXHIBIT
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE
5. CONTRACT REFERENCE 6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
H. DATE J. DATEI. APPROVED BY
The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please DO NOT RETURN your form to the above address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.
Designed using Perform Pro, WHS/DIOR, Aug 96
Ambulance Services Contract F3Q4CA2294AH01
X
N/AA006
Ambulance Operation Service License
78 AMDS/SGPF
N/A IAW Contract Prior of contract
78 AMDS/SGPF 116. REMARKS
Block 7: Inspection-Destination Acceptance- Destination
Block 9: Distribution authorized to Department of Defense (DoD) and DoD Contractors for administrative or operation use determined 23 July 1991. Other request for a copy of the document shall be referred to the block 6, requiring office, on the DD Form 1423 that governs the submittal.
1 Copy of deliverable shall be submitted in digital format. An electronic version of all reports shall be prepared using DoD standard automation software, such as the Microsoft Office Suite (to include excel and word) for test.
ADRESSS: 78 AMDS/SGPF
655 Seventh Street, Bldg 700 Robins AFB, GA 31098-2227
9 Nov 2022
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT-51584/T PWS PARA 1.4.8
0 1 0
SUBMISSIO
SEE BLOCK 16
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor’s performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data. These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government’s right to use the data shall be governed by the pertinent provisions of the contract.
INSTRUCTIONS FOR COMPLETING DD FORM 1423
(See DoD 5010.12-M for detailed instructions.)
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4;
Clarification of submittal dates in Items 12 and 13; Explanation of
(1 Data Item)
C. CATEGORY:
TDP ________ TM _______ OTHER _________________________
Form Approved OMB No. 0704-0188
15. TOTAL
PREVIOUS EDITION MAY BE USED.DD FORM 1423-1, AUG 96 (EG) Page ____ of ____ Pages
A. CONTRACT LINE ITEM NO. B. EXHIBIT
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE
6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
H. DATE J. DATEI. APPROVED BY
The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please DO NOT RETURN your form to the above address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.
Designed using Perform Pro, WHS/DIOR, Aug 96
Ambulance Services Contract F3Q4CA2294AH01
X
N/AA007
Third Party Collection Forms (DD Form 2569):
HCOS/SGSM
N/A IAW Contract As Required of contract
HCOS / SGSM
Daniel Garcia Flores / COR
116. REMARKS
The contractor shall be required to complete the DD Form 2569 Third Party Collections (TPC) form for all civilian personnel transported and deliver each Monday for prior week (showing all activity for Sunday- Saturday).
9 Nov 2022
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT-51585/T
5. CONTRACT REFERENCE
PWS PARA 1.10
See Block 16 As Required
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor’s performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data. These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data.
This is the start of the file's text. The full file is on GovTribe.
File details come from the government source that posted it. Updated .