Vendor Pre-Qualification

This questionnaire is used to evaluate prospective vendor partners for medical services engagements. It is not linked from our public site — please complete all required fields accurately. Submissions are reviewed on a rolling basis and treated as confidential.

All submissions are treated as confidential. Fields marked (required) must be completed.

Point of Contact

Point of Contact Name (required)

Point of Contact Email (required)

Point of Contact Phone

Company Overview

Company Name (required)

Company Headquarters Address (required)

Current Company Size — Number of Employees

Current Company Size — Approximate Annual Revenue

Relevant Experience

Does the company have previous experience with state or federal government issued contracts for the supply of medical personnel and services?

YesNo

If yes, please briefly describe

Does the company have demonstrated experience operating emergency medical response in austere environments?

YesNo

If yes, please briefly describe

Does the company have demonstrated capability to provide 24/7 medical services (Nursing / EMT / Paramedic / Physician Assistant) with physician oversight, via direct observation or remote video support?

YesNo

If yes, please briefly describe

Country Experience

Has the company operated in any of the following countries? (select all that apply)

Solomon IslandsPapua New GuineaPalauTimor-LesteMicronesia

Mobilization & Lead Time

What would the company’s lead time be to provide full services in the above-mentioned countries, including:

a) 2 Teams Day (1 Nurse, 1 Paramedic/EMT, 1 Physician Assistant)

b) 1 Team Night (1 Nurse, 1 Paramedic/EMT, 1 Physician Assistant)

c) All medical equipment and medical consumables

Note: the buyer will supply vehicles, accommodation, meals, and waste disposal for deployed personnel.

Licensing & Services

Does the company currently have, or have the ability to obtain, the necessary licenses to legally provide medical services within country?

Yes, currently haveWould need to obtainNo

Please list all medical services the company is able to supply in-country (required)

Supporting Document

Please upload a current solicitation information brief on your company (PDF or Word, max 2MB)