Trip Request Form
Updated
A PDF document (272 KB) attached to Air Charter Flight for Medical Transportation, from the Federal Prison System / Bureau of Prisons. Due Nov 13, 2026, 9:00 AM (UTC-8).
File name: Trip Request Form.pdf
The full file is for paid members, or buy this bid alone.
Preview
Air Charter/Air Ambulance Trip Quotation Form
(SECTION TO BE COMPLETED BY BOP INSTITUTION STAFF)
Requesting Institution and Address:
USP Atwater
1 Federal Way
Atwater Ca, 95301
Name of Ordering Official:
Phone and Fax Number:
Email:
Type of Service (Circle One):
Air Charter
Ashlie Ybarra
209-386-4791
Air Ambulance
Itinerary
Date
Time
Airport
Depart
11/19/2026
6am
Castle Airport: KMER
Arrive
11/19/2026
Pullman-Moscow: PUW
Depart
11/19/2026
Pullman-Moscow: PUW
Arrive
11/19/2026
Rochester International Airport: RST
Depart
Rochester Internatonal Airport:RST
Arrive
Castle Airport: KMER
BOP Security Staff:
(Include Name and Title)
A. Verna Lieutenant, C. Lanning Officer, T. Vang Officer
BOP Medical Staff:
(Include Name and Title)
None
Number of Inmates:
both inmates require wheelchairs
Special Instructions (Wheelchair, Oxygen, Ventilator, IV, etc):
In case of flight changes or delays, please include an after-hours emergency contact name and phone number: Ashlie Ybarra: 209-349-2825
ASHLIE YBARRA
Digitally signed by ASHLIE YBARRA
Date: 2026.11.09 17:54:18 -08'00'
Name, Title and Signature of Ordering Official
+($/7+6(59,&(6$'0,1,675$725
(SECTION TO BE COMPLETED BY EACH VENDOR)
Vendor Name and POC:
Name of Charter Company (if used):
Type of Aircraft:
Name of Pilot:
Names of Other Crew Members/Medical Staff:
Departure Date and Estimated Time:
Arrival Date and Estimated Time:
Total Number of Air Nautical Miles:
(Based on Great Circle Distance)
Nautical Mile
Additional Costs (i.e., Airport Fees, Fuel Adjustment, Federal Transportation Tax, Catering Fees, etc.) (Please List Separately)
TOTAL COST OF TRIP:
_ Name, Title, and Signature of Vendor
Date
The beginning of the document. Download the full file to read on.