Experience Modification Rate EMR Insurance Contractor Certification.docx

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Attached to
Replace Photo Period Building Federal contract opportunity
Solicitation number
12405B23R0016
Issued by
Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery

About this file

This federal contract opportunity solicits proposals to replace an existing photo period building at the United States Department of Agriculture Agricultural Research Service Southeast Area Sugarcane Field Station in Canal Point, Florida. The contractor shall demolish the existing fire damaged photo period house and build a new one of the exact same footprint, with the exception of moving the locker/breakroom middle bay and constructing a 4x10 foot drying shed on the side of the new building. The solicitation number is 12405B23R0016. This is a total small business set-aside with a NAICS code of 236220 and small business size standard of $45.0M. The contractor must perform all work in strict accordance with the attached statement of work by July 24, 2023. Site visits are encouraged and questions regarding the solicitation must be submitted by July 17.

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EXPERIENCE MODIFICATION RATE (EMR) CERTIFICATION

Contractor Certification Regarding Project: 12405B23R0016 (12405B24R0003) – Replace existing Photo Period Building in accordance with attached Statement of Work (SOW)

2020
2021
2022
2023

Number of serious, willful, or repeat violations from OSHA within the last 4 years. Please attach explanation for any violations. (Three serious, one repeat, or one willful violation shall 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:

Company Name: ____________________________________________

Title:

File details come from the government source that posted it. Updated .