EMR_Certification.docx
DOCX document 13 KB Posted
- Attached to
- Elevator Modernization Federal contract opportunity
- Solicitation number
- 1232SC18R0021
About this file
EMR Certification form
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| ARS372_Request_for_Payment.pdf | ||
| ARS371_Progress_&_Payment_Schdl.pdf | ||
| Amend_1_-_Q&A_Elev_Modernization_NAL.pdf | ||
| Q&A_Elevator_Modernization_NAL_12JUL18.pdf | ||
| Specifications_-_Elev_Modernization_12Apr18.pdf | ||
| Material_Submittal_Register.pdf | ||
| Sol_1232SC18R0021_Elev_Modernization_NAL.pdf | ||
| Wage_Decision_MD58_25May18_-_Elev_Ren_NAL.pdf |
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Text version
Contractor Certification Regarding Project: Project Title Here
| 2014 |
| 2015 |
| 2016 |
| 2017 |
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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