Cost effective

Cost effective

Automated dispatch of vehicles, and online tracking of trips save operating costs.

Efficient

Efficient

Optimized scheduling of trips increases fleet efficiency, and improves customer experience.

Additional revenue

Additional revenue

Trips requested from other hospitals on the platform help utilize free vehicles, and increase revenue.

Risk-free

Risk-free

Powerful technology streamlines operations, and accelerates growth at zero risk.

#

We are launching Safr Care to empower transport providers like you through increased revenue, improved efficiency, and reduced operating costs. Want an exclusive invite to use the Safr Care platform 100% risk-free at no cost for three months?

Part A: Company Contact Information

Ownership Disclosure: Please list the names of any person(s) who are officers, general partners, or directors of the company, and anyone who holds greater than a 5% ownership share.
Owner (Optional):

PART B: CREDENTIALING AND VERIFICATION OF LICENSURE

Insurance & Credentialing Information
Insurance Information
Certificate of Insurance
Vehicle Certification

I certify that I have read Section I (Vehicle Standards) of Circulation's Transportation Provider Performance Standards and that Company is in compliance with all vehicle requirements.

Driver Certification

I certify that I have read Section I (Driver Standards) of Circulation's Transportation Provider Performance Standards and that Company is in compliance with all vehicle requirements.

Other Business Licensure

Please list any other relevant state, local, or other business licensure or certifications you currently hold or intend to obtain in the next three months.

Dispatch Communications

What type of 2-way communication system do you use to talk to your drivers?

PART C: SERVICE AREA AND FLEET OPERATIONS

Company's Service Area
Transportation Services & Fleet's Available Capacity

Directions: For each vehicle type below, enter (1) the number of vehicles in your fleet and (2) the percent of trip capacity that you are able to make available to serve Safr Technologies Inc's rides.

For Example: if you have five sedan vehicles, but a minimum of half their time must be spent serving trips for a hospital contract you hold, then under "Sedan (non-taxi)" you would enter "5" as the "# of vehicles" but since only half their time is available for the trips you'd like from Safr Technologies Inc, then enter "50%" in the "% of Total..." field.

Sedan (non-taxi)
Taxi
Mini Van
Full Size Van
ADA Compliant Wheelchair Van
Non Emergency Stretcher/Gurney
Non-Emergency Ambulance
Other Services Provided

PART D: SERVICES

Service Hours

Directions: Please tell us your normal operating hours in which you will accept trips. Start by selecting the day, start time and end time. Then click link below to add additional days/times.

Medical Transportation Experience
DWMBE Status

If your company qualifies, or is certified as one of the following, please check the appropriate box.

Application Submission Attestation of Truthfulness and Authority

The responses in this application will become part of the Company's official record on file with Safr Technologies Inc and should be submitted by an authorized representative of the Company.

Certification and attestation: By submitting this application I am hereby certifying and attesting that I am an authorized representative of the Company, and that the responses provided in this application have been made truthfully and are accurate to the best of my knowledge.

I agree to all terms, conditions, contracts and exhibits contained herein.