Wisconsin In-Network Transportation Provider Checklist
Wisconsin In-Network Transportation Provider Checklist
Wisconsin In-Network Transportation Provider Checklist
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______________________________________________________________________________________________________________________________________________________________________________________________________________Please describe your driver training and evaluation process: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________QUALITY ASSURANCE PROGRAMWhat steps do you take to monitor and ensure the timeliness, safety, and sensitivity of your transportation services?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________DWMBE STATUSIf your company qualifies, or is certified as one of the following please check the appropriate box and complete theattached DWMBE questionnaire.Type Check Designation Ownership DefinitionSBE Small Business Enterprise Business with less than 500 employeesMBE Disadvantaged Business Business with 51% or more certified defined US minority ownershipWBE Woman Owned Business Enterprise Business with 51% or more certified woman ownershipVET Veteran Business Enterprise Business 51% or more certified US military veteran ownedDVBEDisabled Veteran BusinessEnterpriseBusiness 51% or more certified disabled US veteran ownedDBE Disabled Business Enterprise Business 51% or more certified disabled persons ownedOTHER COMMENTS OR CLARIFICATIONS: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________COMPLETED BY:E MAIL:TITLE:TELEPHONE:DATE:PLEASE FAX FORM TO 877-352-5641, AND MAIL ORIGINALATTENTION: NETWORK DEVELOPMENTEmail questions <strong>Network</strong>@logisticare.comPage 51
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