SAME, Baltimore Post, Membership Profile Questionnaire

Please respond to the items with your expertise in mind whether it is construction, design, consulting, or supply.

The information received will be maintained by the Baltimore Post Readiness Committee and may be used to support the U.S. Army Corps of Engineers, Baltimore District, in the event of a natural or malevolent event within the Baltimore Districts Military and Civil Works boundaries.  All information will be kept confidential.

If you have suggestions to improve this form for next year’s update, please let us know.  Thank you.

SAME Baltimore Post Sustaining Membership Profile
(Voluntary Agreement to Participate)
* Required Field
Company Name*:  
Address*:  
Address (line 2):
City*:  
State*:  

Zip Code*:

  

Phone*:

  

Fax*:

  

Webpage:
Persons to Contact:
 

Primary Contact

  

Alternate Contact
Name*:   Name:
Address*:   Address:
Address: Address:
City*:   City:
State*:   State
Zip*:   Zip:
E-Mail*:   E-Mail:
Phone (Bus.)*:   Phone (Bus):
Fax: Fax:
Cell: Cell:
Home: Home:
Federal/State/Local Contracts Relevant to Emergency Prepardness:
Contract Name: Agency:
Contract Name: Agency:
Contract Name: Agency:
Business Class* (Check ALL that apply to you):
Architecture Transportation Architect-Engineer Construction
Design Build Engineering Communications Environmental
Logistics Management Distribution-Supply Manufacturing
Planning Security Surveying/Mapping/GIS Technical Services
Other:
Emergency Support Functions (FEMA) Capabilities: (Check ALL that apply):
ESF 1: Transportation. Providing civilian and military transportation.
ESF 2: Communications. Providing telecommunications support.
ESF 3: Public Works and Engineering. Restoring essential public services and facilities.
ESF 4: Fire Fighting. Detecting and suppressing wild land, rural and urban fires.
ESF 5: Information and Planning. Collecting, analyzing and disseminating critical information to facilitate the overall federal response and recovery operations.
ESF 6: Mass Care. Managing and coordinating food, shelter and first aid for victims; providing bulk distribution of relief supplies; operating a system to assist family reunification.
ESF 7: Resource Support. Providing equipment, materials, supplies and personnel to federal entities during response operations.
ESF 8: Health and Medical Services. Providing assistance for public health and medical care needs.
ESF 9: Urban Search and Rescue. Locating, extricating and providing initial medical treatment to victims trapped in collapsed structures.
ESF 10: Hazardous Materials. Supporting federal response to actual or potential releases of oil and hazardous materials.
ESF 11: Food. Identifying food needs; ensuring that food gets to areas affected by disaster.
ESF 12: Energy. Restoring power systems and fuel supplies.
Past Hazards Experience:  Please list any relevant events or studies that your firm has or can respond to (limit your response to 100 characters):