Atch 2 - VISA Carrier Vessel Information Sheet

Attachment 2

VISA CARRIER VESSEL INFORMATION SHEET

Business Name:

Vessel Name:

Vessel Type (if applicable, MARAD design type):
System for Award Management (SAM) Information

1. UEI :

2. Cage Code :

3. TIN:

4. Parent TIN (If Applicable):

Large

5. Business Size:

Small

6. Socioeconomic Status:

Physical Address

8(a)

Hubzone

WOSB

SDVOSB

Mailing Address

7. Address Line 1:

8. Address Line 1:

9. Address Line 2:

10. Address Line 2:

11. City:

12. City:

13. State/Province:

14. State/Province:

15. Country:

16. Country:

17. Zip/Postal Code:

18. Zip/Postal Code:

Government Business POC

Broker

19. Name:

20. Name:

21. Phone (Primary):

22. Phone (Primary):

23. Phone (Alt.):

24. Phone (Alt.):

25. Email:

26. Email:

27. Fax:

28. Fax:

Vessel Data

29. Place Built:

30. Year Built:

31. INMARSAT Ident:

32. Vessel's Email/Fax:

33. Call Letters:

34. Official Number:

35. Nationality of Master/Officers/Crew:

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:

Yes

No

VISA CARRIER VESSEL INFORMATION SHEET

Business Name:

Vessel Name:
Pricing Data - Stage 1

40a. Full Operational Status Rate :

40b. Full Operational Status Rate :
(ROS less than 10 days)

40c. Full Operational Status Rate :
(ROS 10 days or longer)

Pricing Data - Stage 2
41a. Full Operational Status Rate :

41b. Full Operational Status Rate :
(ROS less than 10 days)

41c. Full Operational Status Rate :
(ROS 10 days or longer)

Pricing Data - Stage 3
42a. Full Operational Status Rate :

42b. Full Operational Status Rate :
(ROS less than 10 days)

42c. Full Operational Status Rate :
(ROS 10 days or longer)

Rate Methodology
43.

Negotiated

*STAGE II = 115% OF STAGE III RATE

*STAGE I = 140% OF STAGE III RATE

Other Proposed Costs:
44.

VISA CARRIER VESSEL INFORMATION SHEET

Business Name:

Vessel Name:
Vessel Characteristics

45. Net Registered Tonnage:

46. Gross Register Tonnage:

47. Panama Canal Tonnage:

48. Suez Canal Tonnage:

49. Beam (Extreme):

50. Length Overall:

a. (ft)
b. (m)
51. Immersion (on draft in Box 48):

a. (ft)
b. (m)

52. Length between Perpendiculars:

a. (LT/in)

53. Summer mean draft:

a. (ft)
b. (m)
54. Deadweight Capacity (on draft in Box 48):

b. (t/cm)

a. (ft)
b. (m)
55. Displacement, Loaded (on draft in Box 48):

a. (LT)
b. (t)

56. Summer Load Line Freeboard:

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

57. Shaft Horsepower/Kilowatts:

a. (ft)
b. (m)

58. Brake Horsepower/kilowatts:

a. (hp)

b. (kW)

a. (hp)
Cargo Capacity
59. Total Grain Gubic Capacity (cu ft/ cu meters underdeck, exclusive of