Sol_140A1522R0001.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

A15

Nashville TN 37214

545 MARRIOTT DRIVE SUITE 700

Contracting Office

DOI, BIA ERO

CODE 16. ADMINISTERED BYCODE

X

X

922160

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED ORA15

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

03/10/2022 1700 ES

02/10/2022

(615) 564-6970Andrew Rhoades (No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBER a. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

140A1522R0001

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 9 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

15. DELIVER TO

Nashville TN 37214 Contracting Office

545 MARRIOTT DRIVE SUITE 700

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

BIA ERO 00015

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

A Blanket Purchase Agreement(s) (BPA) will be issued as the mechanism to reimburse the Fire Department for emergency response services to the Tonawanda Band of Seneca Indians to include emergency medical services, accidents, structural, and wildland fires for the protection of Tribal residents, natural resources, forests, and wildlands that are subject to the oversight of the Bureau of Indian Affairs (BIA).

Period of Performance: 07/01/2022 to 06/30/2023 Continued ...

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED

Andrew Rhoades

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

9 2 of

SCOPE OF SERVICES

SECTION 1. GENERAL INFORMATION

1.1 Purpose

This Blanket Purchase Agreement (BPA) is being issued as the mechanism to reimburse the Fire Department for emergency response services to the Tonawanda Band of Seneca Indians to include emergency medical services, accidents, structural, and wildland fires for the protection of Tribal residents, natural resources, forests, and wildlands that are subject to the oversight of the Bureau of Indian Affairs (BIA). For further information on the region see:

https://www.bia.gov/regional-offices/eastern .

The Contractor, also referred to as the Fire Department, must be a duly constituted fire department, fire district, or non-profit association or political subdivision of the state authorized to provide emergency services within the boundary of the State of New York and must be authorized to enter this BPA by its governing body. The Contractor must have the ability to respond and provide the services outlined in this Scope of Services subject to the oversight of the BIA on a timelier and more effective basis than other resources in the state.

Department of the Interior, Bureau of Indian Affairs, Eastern Region plans to establish multiple BPA’s for this requirement. The Government contemplates awarding BPA’s to all qualifying fire departments that handle fire and emergency services within the area that can provide response times of less than twenty minutes without undue delay occurrences.

This BPA does not commit the government to pay any cost for the preparation and submission of a proposal. Furthermore, the government is under no obligation to procure any supplies or services relative to this request. You are reminded that the Contracting Officer is the only person who can legally commit the government to the expenditure of funds in connection with this requirement.

1.2 Scope of Work

The Fire Department must provide all personnel, equipment, tools, materials, supervision, and other items and services necessary to perform services as defined in this Scope of Services.

The fire department must perform to the standards in this BPA as listed in the Scope of Services.

SECTION 2. ADMINISTRATION

2.1 Authorized BIA Representative.

The term "BIA Representative" shall be used in this BPA to generally identify BIA personnel authorized to perform specified duties and functions related to the BPA, and shall include any one or more of the following BIA personnel, acting alone or in concert:

a. Regional Office Fire Management Officer; or

b. A technical specialist or any other person authorized by the Regional Director to perform a specific function or functions related to this agreement.

https://www.bia.gov/regional-offices/eastern

2.2 Contractor Personnel

The BIA assumes that the Fire Chief will be the person responsible for administration of this BPA. The Contractor must notify the BIA in writing if the person responsible is someone other than the Chief.

Standards and qualifications for all BPA employees and/or volunteers are outlined under the Fitness and Training Qualifications Section.

SECTION 3. SERVICE AREA

3.1 Contractor’s Normal Operating Area

The Contractor’s Normal Operating Area encompasses (1) Contractor’s Primary Response Area, which is the geographic area in which Contractor is the primary provider of emergency services, including areas which Contractor serves in accordance with a BPA for provision of primary services to any other entity or entities; and (2) the areas in which the Contractor provides Mutual-Aid under current Mutual-Aid agreements between the Contractor and other Fire Departments. The boundary of Contractor’s Normal Operating Area, with the locations of Contractor’s Primary Response Area, and the area subject to Mutual-Aid by Contractor within said boundary, including the primary response areas of other firefighting entities, are shown on the map attached hereto as Attachment 2 and expressly incorporated into and made a part of this contract. The Contractor shall provide the BIA Representative with an update of this map in the event of any change in the Normal Operating Area boundary.

SECTION 4. INDIAN LAND

4.1 Indian Land

The term "Indian lands" as used in this BPA means surface land within the administrative boundary of the Regional Office, title to which is held (1) by the United States in trust for an Indian tribe or for an individual member of an Indian tribe, or (2) by an Indian tribe or by a member of an Indian tribe subject to a restriction by the United States against alienation. For payment purposes related to this BPA only, the locations of tracts which have been identified by the BIA as known or presumed Indian land located within Contractor’s Normal Operating Area, based on the best available information, are shown on a map to be provided to Contractor no later than the effective date of this contract. Any erroneous identification or non-identification of Indian land on said map may be subject to correction by either party to this contract, upon presentation of proof of the status of said land. The map may be updated on an annual basis or as new information becomes available.

SECTION 5. PROVISION OF EMERGENCY SERVICES BY CONTRACTOR

5.1 Contractor’s Primary Services

The Contractor shall respond to emergency responses within the boundaries of the Tonawanda Band of Seneca Indians Reservation as needed.

5.2 Reporting Requirements

Contractor to provide with the invoice, a breakdown of the number and type of responses with the date, time, and location noted.

If the service provided is a wildland fire, the Contractor agrees to first submit a BIA Individual Wildland Fire Report (DI-1202) without an invoice. Once the DI-1202 has been reviewed and approved by the BIA representative, the Contractor will be notified to submit the official invoice.

Any invoice submitted without an approved DI-1202 will be returned. Invoice for Wildland Fire Responses are also required to be submitted separately from the invoices for Emergency Response since they are paid out of different funding. DI-1202 will be submitted within 5 days of the ending date of Contractor’s wildland fire response on known Indian wildland, and no later than 30 days from the ending date of Contractor’s wildland fire response on wildland later discovered to be Indian wildland. This requirement is necessary, due to these funds coming from suppression funding and not tribal funding.

5.3 Invoicing Requirements

Contractor will submit one invoice for delivered equipment to the IPP platform located at:

https://www.ipp.gov/ . Invoices shall comply with Federal Acquisition Regulation 52.212-4(g).

SECTION 6. GOVERNMENT FURNISHED EQUIPMENT AND SUPPLIES

6.1 Joint Fire Prevention Activities

The BIA may provide, if funding is available, prevention materials to the Contractor. The Contractor shall participate to the extent possible in Indian wildland fire prevention activities with the BIA in the Contractor’s Primary Response Area when requested by a BIA Representative.

6.2 Technical Assistance

The BIA may offer to the Contractor’s organization, training, technical assistance, and any other expertise available on its staff.

SECTION 7. BPA FURNISHED EQUIPMENT AND SUPPLIES

7.1 Provision and Condition of Equipment.

The Contractor shall provide all equipment used by the Contractor in performing functions under this contract. All equipment furnished by the Contractor under this BPA must be met the minimum standards for equipment established by the National Fire Protection Association.

7.2 Equipment Operating Supplies

The Contractor shall provide equipment operating supplies unless otherwise expressly stated in this contract. Equipment operating supplies are consumables and include but are not limited to fuel, oil, filters, batteries, and other similar types of consumable supplies.

7.3 Equipment Repairs

Repairs to equipment shall be made and paid for by the Contractor unless otherwise expressly stated in this contract.

https://www.ipp.gov/

7.4 Loss, Damage or Destruction of Equipment or Supplies

The Contractor may be reimbursed if such losses, damages, or destruction were directly caused by the fire being suppressed and if its employees and/or operational failures in the equipment were not a contributing factor to such damage, to the extent not covered by Contractor’s insurance. Claims shall be processed in accordance with the Contract Disputes Act of 1978.

SECTION 8. FIREFIGHTER FITNESS AND TRAINING QUALIFICATIONS

8.1 Minimum Standards for Firefighters Engaged in Emergency Responses on Indian land within Contractor’s Normal Operating Area.

The Contractor shall establish and maintain written physical fitness and training standards for firefighters engaged in emergency responses on Indian land within its Normal Operating Area for purposes of this contract, to ensure that each of its firefighters possess adequate physical condition to meet the arduous demands of firefighting and that each of it firefighters is trained to safely execute emergency services tactics and strategies. These standards shall be included in the Contractor’s Standard Operating Procedures.

8.2 Certification of Qualifications

The Contractor shall certify to the BIA that each of its firefighters participating in emergency responses on Indian land within or outside the Contractor’s geographic protection area meet and adhere to the minimum standards for such activities as set forth in this Section before use of the firefighter for purposes of this Contract.

SECTION 9. SAFETY REQUIREMENTS

9.1 Personal Protective Equipment

Each of the Contractor’s firefighters shall be required to utilize personal protective equipment that follows National Fire Protection Association standards while actively engaged in an Indian fire response.

9.2 Compliance with Safety Rules and Standards

The Contractor shall comply with all National Fire Protection Association rules and standards.

SECTION 10. PAYMENT RATE

10.1 Reimbursement to Contractor for Primary Services

The BIA shall reimburse the Contractor for the cost incurred by such party for emergency response activities within the Contractor’s Primary Response Area, in accordance with the payment provisions in this Section.

10.2 Reimbursement to Contractor for Payment for Mutual-Aid by another Entity

If another entity provides "mutual aid" by assisting with Contractor’s emergency response activities in Contractor’s Primary Response Area, the Contractor shall be responsible for any payment due said entity and will not be eligible to request reimbursement from the BIA.

10.3. Rates for Response

The BIA shall pay the Contractor a flat rate of $800.00 for each call. The rate has been determined fair and reasonable based on like services provided by other fire departments in the local area. In the event of a false alarm or cancelation, the BIA may reimburse the Contractor if there were expenses.

No funding is obligated to the BPA. As monthly invoices are received, funding will be obligated under a BPA Call. Once the BPA Call has been processed, a copy will be provided to the contractor will instructions to invoice in IPP. See FAR Clauses 52.232-18, AVAILABILITY OF

FUNDS.

Invoices should be submitted monthly as outlined in Section 5.2.

10.4 Deductions from Payments and Reimbursements

Unless specifically stated elsewhere in this contract, the cost of any commissary items, supplies, materials, or services provided to the Contractor by the BIA, including operating supplies and/or equipment repairs provided by the BIA pursuant to Section 7 of the contract, shall be deducted from the payment or reimbursement to the Contractor.

SECTION 11. FUNDING

Tribal Contracting Authority. P.L. 93-638, Title I, gives the Tonawanda Band of Seneca Indians the authority to Contract with the BIA, any programs, or services, which are otherwise provided to the Indian Tribes and their members pursuant to Federal Law. Prior to negotiating this contract, the Tonawanda Band of Seneca was notified of this funding pursuant to P.L. 100-472 and given the first right to contract. Since the Tonawanda Band of Seneca declined, the BIA is responsible to provide this service.

The funding obligated to this BPA through BPA Calls is received yearly for this service on behalf of the Tonawanda Band of Seneca Indians and is calculated based upon the Tribal Priority Allocation System. The amount of funding received could increase or decrease each fiscal year depending upon the annual Budget for BIA.

The Government’s obligation under this BPA is contingent upon the availability of appropriated funds from which payment for BPA purposes can be made. No legal liability on the part of the Government for any payment may arise until funds are made available to the Contracting Officer for this contract. See FAR Clause 52.232-18, Availability of Funds.

SECTION 12. BENEFITS AND INSURANCE

The Contractor shall pay all salaries, insurance, pensions, and other benefits provided to firefighters regularly employed by the Contractor. Nothing herein waives or limits the responsibility of the Contractor and any entity providing mutual aid to the Contractor on Indian land to provide Workers Compensation coverage for its own employees as defined by State Statutes, who perform services pursuant to this Contract. The Contractor shall provide an Annual Certificate of Insurance to the Contracting Officer as evidence that policies providing the required coverage and limits are in full force and effect for its employees who may perform services pursuant to this contract. Where a claim for Workers Compensation is made, the employee's entity is responsible for providing the Workers Compensation coverage regardless of where the action occurred or the law that was being enforced.

SECTION 13. LIABILITIES AND IMMUNITIES

Notwithstanding any other provision in this Contract, the BIA, including its agents, employees, and insurers, shall not have the authority or any right whatsoever to control in any manner the day-to-day discharge of the duties and/or activities of the Contractor’s employees, and do not assume any responsibility or liability for the actions of Contractor’s employees which are performed within or outside the scope of their duties. Contractor and its agents, employees, contractors, and volunteers shall be deemed independent contractors, and shall not be deemed agents of the BIA for any purpose.

SECTION 14. INSPECTION AND AUDIT OF RECORDS

The Contractor shall retain all books, accounts, reports, files, and other records ("Records") relating to this BPA for a period of five years after completion of this contract. All records shall be subject to inspection and audit by the BIA at all reasonable times. Upon request, the Contractor shall produce the original of all such records at the offices of the BIA.

SECTION 15. TERM OF BPA

This BPA will be instituted on July 1, 2022 – June 30, 2023, with four optional periods:

• Option year of service one – July 1, 2023 – June 30, 2024

• Option year of service two – July 1, 2024 – June 30, 2025

• Option year of service three – July 1, 2025 – June 30, 2026

• Option year of service four – July 1, 2026 – June 30, 2027

SECTION 16. GENERAL NOTES

1. The North American Industry Classification System (NAICS) codes for this agreement is:

922160 “Ambulance and Fire Service Combined.”

2. (PSC) S202 or L042.

3. Solicitation dates: 2/11/2022 – 3/10/2022

4. Source selection criteria:

a. Past performance

b. Availability

c. Delivery time capability

d. Compliance with qualifications

5. The Bureau of Indian Affairs, Eastern Region will establish a Blanket Purchase Agreement(s) resulting from this solicitation in accordance with the factors listed in item four of this section. Accordingly, the Government may establish a BPA with other entities as considered necessary to maintain proper service levels to the tribe.

6. Services qualifying for this BPA shall have addresses within the attached boundary map (Attachment 1).

SECTION 17. CONTRACT CLAUSES

52.252-2 Clauses Incorporated by Reference (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at www.acquisition.gov/far.

FAR:

52.204-6 Unique Entity Identifier OCT 2016 52.204-7 System for Award Management OCT 2018 52.204-12 Unique Entity Identifier Maintenance OCT 2016 52.204-13 System for Award Management Maintenance OCT 2018

52.204.19 Incorporation by Reference of Representations and DEC 2014

Certifications

52.204.25 Prohibition on Contracting for Certain Telecommunications and NOV 2021

Video Surveillance Services or Equipment 52.212-3 Offeror Representations and Certifications-Commercial Products NOV 2021

And Commercial Services 52.212-4 Contract Terms and Conditions-Commercial Items NOV 2021 52.212-5 Contract Terms and Conditions Required To Implement Statutes JAN 2022

Or Executive Orders-Commercial Products and Commercial Services

52.214-34 Submission of Offers in the English Language APR 1991 52.214-35 Submission of Offers in U.S. Currency APR 1991 52.217-9 Option to Extend the Term of the Contract MAR 2000 52.222-55 Minimum Wages for Contractor Workers Under Executive Order JAN 2022

14026 52.222-62 Paid Sick Leave Under Executive Order 13706 JAN 2022 52.223-18 Encouraging Contractor Policies to Ban Text Messaging While JUN 2020

Driving 52.225-1 Buy American-Supplies NOV 2021 52.225-25 Prohibition on Contracting with Entities Engaging in Sanctioned JUN 2020

Activities Relating to Iran-Representation and Certification 52.229-3 Federal, State, and Local Taxes FEB 2013 52.232-18 Availability of Funds APR 1984 52.232-39 Unenforceability of Unauthorized Obligations JUN 2013 52.233-3 Protest After Award AUG 1996 52.233-4 Applicable Law for Breach of Contract Claim OCT 2004 52.244-6 Subcontracts for Commercial Products and Commercial JAN 2022

Services

DIAR:

1452.201-70 Authorities and Delegations SEP 2011 1452.204-70 Release of Claims JUL 1996 1452.280-3 Subcontracting Limitations JUL 2013 http://www.acquisition.gov/far

<Double-click here to enter title> Tuscarora and Tonawonda Tribal Lands 04JAN2022 Bureau of Indian Affairs

Eastern Region

Tonawanda

Tuscarora Nation

Map Created By: RtKerbow NC-ECA FIRE MANAGEMENT

Allegany

Cattaraugus

Tonawanda Tuscarora Nation

Oil Springs

LOCATOR MAPI

0 52.5 Miles

U.S. Department of the Interior – Bureau of Indian Affairs

INDIVIDUAL FIRE REPORT

GENERAL REPORTING INFORMATION

BIA Region Reporting Unit Calendar Year Fire Number FireCode Fire Type / Protection Type

Incident Name Cause Category Burning Index

STATISTICAL DATA

No. State Owner Vegetation Burned Acres No. State Owner Vegetation Burned Acres

LOCATION DATA

Reservation Origin - Owner Origin - Accuracy Location - Method Datum

Latitude Longitude UTM Degrees Minutes Seconds Degrees Minutes Seconds Zone Easting Northing

FIRE MANAGEMENT DATA

Date Time Type Amount Acres

Discovery / Start

Initial Attack

Controlled / Completed

Declared Out

SITE DATA

Topography Aspect Slope Elevation Weather Station FBPS Fuel Model

MSGC

NFDRS Fuel Slope Grass Climate

Wildland Urban Interface (WUI)?

Yes No

Structures Number of homes & significant structures burned/destroyed

FIRE ECOLOGY

Condition Class Condition Class No. Fire Regime

Group Pre-fire Post-fire Acres No. Fire Regime

Group Pre-fire Post-fire Acres

Form DI-1202-BIA ver. 5/2007 Page 1 of 2

Individual Fire Report Record Identifier (Copy from page 1)

Reporting Unit Calendar Year Fire Number

GENERAL REMARKS Note: Attach a topographic map showing the perimeter for fires that are 100 acres or larger.

TRESPASS INVESTIGATION SUB-FORM – FOR HUMAN-CAUSED FIRES

FIRE CAUSE INFORMATION

Cause Code (General – Specific) Other Cause (if “Other – Known”) Suspect Classification

Was Fire Investigated?

Yes No

Suspect Identify

Known Unknown

Suspect Type

Resident Transient Unknown

TRESPASS/INVESTIGATION REMARKS

FUELS MANAGEMENT DATA SUB-FORM – FOR PRESCRIBED AND WILDLAND FIRE USE FIRES

PROJECT INFORMATION

Local Project Number NFPORS Treatment Number Firing Type Plot Burn Objectives Strategy Method #1 #2 #3

Cost Per Acre Escape? Overall Treatment Complexity Was this converted to a wildfire (suppression action taken)? Yes No

If “Yes”, Fire Number for the corresponding suppression action:

Very Low Low Moderate High

SIGNATURE BLOCK

Name Title Date

Data Provided By:

Authorized By:

Report Entered By:

Form DI-1202-BIA ver. 5/2007 Page 2 of 2

BIA Region:

Reporting Unit:

Calendar Year:

Fire Number:

FireCode:

Fire Type Protection Type:

Incident Name:

Cause Category:

Burning Index:

State1:

Owner1:

Vegetation1:

Burned Acres1:

State5:

Owner5:

Vegetation5:

Burned Acres5:

State2:

Owner2:

Vegetation2:

Burned Acres2:

State6:

Owner6:

Vegetation6:

Burned Acres6:

State3:

Owner3:

Vegetation3:

Burned Acres3:

State7:

Owner7:

Vegetation7:

Burned Acres7:

State4:

Owner4:

Vegetation4:

Burned Acres4:

State8:

Owner8:

Vegetation8:

Burned Acres8:

Reservation:

Origin Owner:

Origin Accuracy:

Location Method:

Datum:

Degrees:

Minutes:

Seconds:

Degrees_2:

Minutes_2:

Seconds_2:

Zone:

Easting:

Northing:

TimeDiscovery Start:

TypeDiscovery Start:

Acres:

TypeInitial Attack:

Initial Attack:

TypeInitial Attack_2:

Initial Attack_2:

TypeInitial Attack_3:

Initial Attack_3:

TypeInitial Attack_4:

Initial Attack_4:

TypeInitial Attack_5:

Initial Attack_5:

AcresRow2:

DateControlled Completed:

TimeControlled Completed:

Acres_2:

DateDeclared Out:

Topography:

Aspect:

Slope:

Elevation:

Weather Station:

FBPS Fuel Model:

NFDRS Fuel:

Slope_2:

Grass:

Climate:

Structures Number of homes significant structures burneddestroyed:

Fire Regime Group1:

Prefire1:

Postfire1:

Acres1:

Fire Regime Group4:

Prefire4:

Postfire4:

Acres4:

Fire Regime Group2:

Prefire2:

Postfire2:

Acres2:

Fire Regime Group5:

Prefire5:

Postfire5:

Acres5:

Fire Regime Group3:

Prefire3:

Postfire3:

Acres3:

Individual Fire Report Record Identifier Copy from page 1:

Reporting Unit_2:

Calendar Year_2:

Fire Number_2:

GENERAL REMARKS:

Cause Code General Specific:

Other Cause if Other Known:

Suspect Classification:

TRESPASSINVESTIGATION REMARKS:

Local Project Number:

NFPORS Treatment Number:

Strategy:

Method:

1:

2:

3:

Cost Per Acre:

Yes NoIf Yes Fire Number for the corresponding suppression action:

NameData Provided By:

TitleData Provided By:

DateData Provided By:

NameAuthorized By:

TitleAuthorized By:

DateAuthorized By:

NameReport Entered By:

TitleReport Entered By:

DateReport Entered By:

DateDiscovery Start:

IA Start:

WUI YES: Off

WUI NO: Off

FI Y: Off

FI N: Off

SI Y: Off

SI N: Off

ST R: Off

ST T: Off

ST U: Off

Escape Y: Off

Escape N: Off

OTC VL: Off

OTC L: Off

OTC M: Off

OTC H: Off