KBR

____________________________________________________________ Government and Infrastructure LOGCAP III HQ Operations, Camp Victory, APO AE 09342 Phone: 281-669-5620

Attachment [ii]

LOGCAP III HSE / HQ

Primary and secondary POC for Subcontractors and its Location Medical Facilities Profile and Locations of Operations Physicians Office with Telephone number Laboratory with Telephone number Radiology Facility with Telephone number Primary and secondary POC for All Medical Facilities All Medical Facilities Credentials and Certifications All Medical Providers Credentials and Certifications

Documents required for Subcontractor Medical Provider Approval

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SAMPLE COPY
1 Primary and Secondary POC for Subcontractors and its Location
XXXXXXXX internationals Mr.YYYYYYYYYYY - POC for the company AREA - ZZZZZ Project Manager CONTACT PHONE NUMBER - FAX NUMBER Iraqna 0790xxxxxxxxxx EMAIL xxxxxxxxxxxx@yyyyyyyy.com

Medical Facilities Profile and Locations of Operations

xxxxx Medical Centre Address - complete address with zip code Tel: +++ 00 - Contry - Area -code - Number Fax : ++00 - Contry - Area -code - Number Person to Contact : Mr. So and so Mob: +00 number
Email address

xxxxx Medical clinic /Lab /Health centre Address - complete address with zip code Tel: +++ 00 - Contry - Area -code - Number Fax : ++00 - Contry - Area -code - Number Person to Contact : Mr. So and so Mob: +00 number
Email address

Medical Facilities Profile and Locations of Operations Softcopy of Brief Profile in attachments in PDF format if any .
3 Physicians Office with Telephone number

Name of the Doctor Qualifications and credentials

Licence number Tel: +++ 00 - Contry - Area -code - Number Fax : ++00 - Contry - Area -code - Number
Email address

Laboratory with Telephone number

POC - Name of the Laboratory Licence number - Certificate number Lab Technicians credentials Tel: +++ 00 - Contry - Area -code - Number Fax : ++00 - Contry - Area -code - Number
Email address

Radiology Facility with Telephone number

Name of Radiology facility Xray Machine used Number - Name of the Machine Availability of Radiologist Xray Technicians Name - Credentials Tel: +++ 00 - Contry - Area -code - Number Fax : ++00 - Contry - Area -code - Number
Email address

Primary and secondary POC for All Medical Facilities

Primary POC for Medical Facility Address - complete address with zip code Tel: +++ 00 - Contry - Area -code - Number Fax : ++00 - Contry - Area -code - Number Person to Contact : Mr. So and so Mob: +00 number
Email address

Secondary POC for Medical facility Address - complete address with zip code Tel: +++ 00 - Contry - Area -code - Number Fax : ++00 - Contry - Area -code - Number Person to Contact : Mr. So and so Mob: +00 number
Email address

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All Medical Facilities Credentials and Certifications All Medical Providers Credentials and Certifications

All Medical Facilities Credentials and Certifications - PDF Format scanned copies All Certificates if in any other language other than English need an official Translated copy to accompany the original scanned document -PDF format Scanned copies of the Department of Health & Medical Services Certifications of Physicians and Specialist Doctors .PDf format ISO -9001/2000 or GCC certicications if any - if not please mention -PDF format All Medical Providers Credentials and Certifications- PDF format

Halliburton
Kellogg Brown and Root Proprietary Data NOTE: This document contains information which may be withheld from the public because disclosure would cause a foreseeable harm to an interest protected by one or more Exemptions of the Freedom of Information Act, 5 USC Section 552. Furthermore, it is requested that any Government entity receiving this information act in accordance with DoD 5400.7R, and consider this information as being for official use only (FOUO), and mark, handle and store this information so as to prevent unauthorized access.