VISA_Carrier_Vessel_Information_Sheet.pdf

Vessel Data

29. Place Built: 30. Year Built:

31. INMARSAT Ident: 32. Vessel's Email/Fax:

25. Email:

27. Fax:

Broker

20. Name:

22. Phone (Primary):

24. Phone (Alt.):

26. Email:

28. Fax:

23. Phone (Alt.):

3. TIN: 4. Parent TIN (If Applicable):

Government Business POC

19. Name:

21. Phone (Primary):

5. Business Size: 6. Socioeconomic Status:

15. Country:

17. Zip/Postal Code:

8. Address Line 1:

10. Address Line 2:

12. City:

14. State/Province:

16. Country:

18. Zip/Postal Code:

Physical Address Mailing Address

7. Address Line 1:

9. Address Line 2:

11. City:

13. State/Province:

Business Name: Vessel Name:

System for Award Management (SAM) Information

1. DUNS Number : 2. Cage Code :

Vessel Type (if applicable, MARAD design type):

36. Classification Society Entered and Class Assigned:

37. Number of Persons Other than Crew that can be carried:

38. Insured Value of Vessel (USD): 39. MARAD Subsidized Vessel:

33. Call Letters: 34. Official Number:

35. Nationality of Master/Officers/Crew:

Large Small 8(a) Hubzone

WOSB SDVOSB

Yes No

VISA CARRIER VESSEL INFORMATION SHEET

40a. Full Operational Status Rate :

40c. Full Operational Status Rate :

(ROS less than 10 days)

$ ______________ USD per diem $ ______________ USD per diem

41a. Full Operational Status Rate :

41c. Full Operational Status Rate :

(ROS less than 10 days)

$ ______________ USD per diem $ ______________ USD per diem

42a. Full Operational Status Rate :

42c. Full Operational Status Rate :

(ROS less than 10 days)

$ ______________ USD per diem $ ______________ USD per diem

43.

Method A Method B Method C Revenue Based Peacetime Rate Based Negotiated

*STAGE II = 115% OF STAGE III RATE

*STAGE I = 140% OF STAGE III RATE

44.

41b. Full Operational Status Rate :

(ROS less than 10 days)

$ ______________ USD per diem

Business Name: Vessel Name:

Pricing Data - Stage 1

If a contractor selects Methodolgy A or B, and the head of the contracting agency determines the contractor's accounting cannot suport either method then the contractors shall negotiate all rates with the contracting activity pursuant to Method C.

Rate Methodology Proposed

Pricing Data - Stage 3

42b. Full Operational Status Rate :

(ROS less than 10 days)

$ ______________ USD per diem

40b. Full Operational Status Rate :

(ROS less than 10 days)

$ ______________ USD per diem

Pricing Data - Stage 2

Other Proposed Costs:

$ _____________ for Crew, Bonuses, and Payments for the Carriage of Ammunition and Hazardous Cargo (See III(a)(1))

Vessel Name:Business Name:

Vessel Characteristics

a. (ft) b. (m)

54. Deadweight Capacity (on draft in Box 48):

a. (LT) b. (t)

45. Net Registered Tonnage: 46. Gross Register Tonnage:

47. Panama Canal Tonnage: 48. Suez Canal Tonnage:

a. (ft) b. (m) a. (ft) b. (m)

49. Beam (Extreme): 50. Length Overall:

51. Immersion (on draft in Box 48):

a. (LT/in) b. (t/cm)

52. Length between Perpendiculars:

a. (ft) b. (m)

53. Summer mean draft:

55. Displacement, Loaded (on draft in Box 48):

a. (LT/in) b. (t/cm)

56. Summer Load Line Freeboard:

a. (ft) b. (m)

57. Shaft Horsepower/Kilowatts: 58. Brake Horsepower/kilowatts:

a. Square Footage of Cargo Space (note particularly total sqft, sqft with 10 ft clearance, sqft underdeck, RoRo Space):

b. Square Meters of Cargo Space (note particularly total sqm, sqm with 10 ft clearance, sqm underdeck, RoRo Space):

61. Number of Tween Decks:

63. Total Underdeck Container Capacity (TEU/FEU):

a. (hp) b. (kW) a. (hp) b. (kW) Cargo Capacity

59. Total Grain Gubic Capacity (cu ft/ cu meters underdeck, exclusive of deep tanks, wing tanks, reefer spaces and spaces fitted with cell guides:

60. Total Bale Cubic Capicity (cu ft/ cu meters underdeck, exclusive of deep tanks, wing tanks, reefer spaces and spaces fitted with cell guides:

62. Cargo Space

70. General Description of Ramps (number, location, size, capacity, and type):

(note particularly weight of heaviest permissible vehicle in LT or t)

64. Total On-Deck Container Capacity (TEU/FEU):

65. Total Refriferated-Container Capacity (TEU/FEU, including number/style of outlets):

66. Reefer-Space Capacity (cu ft/ cu meters):

67. Deep-Tank Capacity (cu ft/ cu meters/bbls):

68. Capacity of Spaces Fitted with Cell Guides (TEU):

69. Amount and Location of Permanent Ballast Carried:

74. Minimum Vessel Fuel Specifications:

Knots: Net bbls per mile: Net bbls per day: Operating Range:

Fuel Consumption

73. Service Speed Fuel Consumption

a. Laden (Average Speed and Consumption for Moderate Weather Passage)

Knots: Net bbls per mile: Net bbls per day: Operating Range:

b. Ballast (Average Speed and Consumption for Moderate Weather Passage)

72. Number/Location/SWL Capacity of Winches, Derricks, Booms, and Cranes:

Business Name: Vessel Name:

Cargo Capacity

Gear

71. General Description of Cargo Spaces and Special Features:

(Decks: number, size in sqft and cu ft; size in sqm and cu m; strength in psf/kPa; arrangement) (Holds and Hatches: number and size) (Hatch Covers: number, size, composition, and type) (Underdeck Height Restriction) (Barge-Stowage Particulars) (Float-on/Float-off Particulars) (Description of Lashing Points: lashing and securing gear, type description, and amount on board)

76. Provide any additional applicable comments.

Business Name: Vessel Name:

Other Contracts Supported by Vessel

Comments

75. List all contracts by agency supported by the vessel (i.e. MSC Charters, USC, RDC and other agency contracts).

(Provide agency name and contract number)