EMR_Certification.docx

DOCX document 13 KB Posted Apr 30, 2019

Attached to: ADA Access Upgrades Phase 1 Federal contract opportunity
Solicitation number: 12305B19R0009
Issued by: Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery Northeast Area

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EMR certification

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Other files for this federal contract opportunity

Other files attached to ADA Access Upgrades Phase 1, newest first.
File	Type	Posted
Self_Performed_Work_worksheet.docx	DOCX document	Apr 30, 2019
Final_Specifications.pdf	PDF	Apr 30, 2019
Solicitation_12305B19R0009_ADA_Access_Phase_1.pdf	PDF	Apr 30, 2019
Drawings.pdf	PDF	Apr 30, 2019
Wage_Decision_MA1_22FEB19_-_ADA_Access_Upgrades_HNRCA_Boston.pdf	PDF	Apr 30, 2019

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Contractor Certification Regarding Project: Project Title Here

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Number of serious, willful, or repeat violations from OSHA within the last 3 years. Please attach explanation for any violations. (Four serious, one repeat, or one willful violation could result in being determined non-responsible.)

Company’s Current Insurance Experience Modification Rate (EMR) = _____________ (Note: Contractor must support the EMR with a signed letter from Insurance Carrier on their letterhead.)

Signature: ______________________________________________

Typed Name: ______________________________________________________

Title: ______________________________________________________

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