Attachment_I-_Malpractice_Insurance_form.docx
DOCX document 13 KB Posted
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- Mobile MRI - N6264519R0040
- Solicitation number
- N6264519R0040
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Solicitation Attachment I - Malpractice
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Other files
| File | Type | Posted |
|---|---|---|
| N6264519R0040_Amendment_02_Released.pdf | ||
| N6264519R0040_Amendment_01_Released.docx | DOCX document | |
| N6264519R0040_Amendment_01.docx | DOCX document | |
| Attachment_V-_US.docx | DOCX document | |
| Attachment_III-_Pricing_Sheet.xlsx | XLSX spreadsheet | |
| Attachment_IV-_HIPAA.docx | DOCX document | |
| Attachment_VI_-_PPIS.docx | DOCX document | |
| N6264519R0040.docx | DOCX document | |
| Attachment_II-Range_of_MRI_(2).docx | DOCX document |
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Attachment I Attachment I- Malpractice Insurance Certification Form Contractors shall complete the following and submit it with their offer. Awardee shall update and resubmit form annually.
1. Contractor has or will maintain(ed) malpractice insurance in compliance with the terms and conditions of this solicitation (including FAR Clause 52.237-7, Indemnification and Medical Liability Insurance).
_______Yes _______No Reasons:
| 2. Insurer:________________ | Insuree:________________ |
| Address:___________________ | _______________________ |
| ____________________ | _______________________ |
| ____________________ | _______________________ |
Phone:_____________________
3. Is or will yours be a group plan or are proposed physicians individually insured?
__________Group ___________By individual
4. Is malpractice coverage ___ occurrence or ___ claims made?
5. If claims made, is extended reporting endorsement (tail) provided? ___ (Yes/No/NA) For how long a period? ___ years
Can the tail be invoked within 90 days of notification by the Government? __ (Yes/No)
6. What is the extent of coverage?
7. $ ________ per incident
8. $________aggregate
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