S02 PRE-AWARD CONTRACTOR EVALUATION FORM.pdf
PDF 93 KB Posted
- Attached to
- Z1DA--518-23-321 Bldg. 78 HVAC Replacement Federal contract opportunity
- Solicitation number
- 36C24124B0005
About this file
This document contains a pre-award contractor evaluation form for federal contractors to complete and submit with proposals. The form requests information on company safety records including OSHA 300 and 300a forms from the past three years, North American Industry Classification System code, safety program administrator, and experience modification rates. An accompanying federal contract opportunity is for HVAC replacement at Building 78 of a Department of Veterans Affairs medical center. The solicitation type is an invitation for bid, and the opportunity is with the Veterans Health Administration Veterans Integrated Service Network 1 agency.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C24124B0005 0006.docx | DOCX document | |
| Limitations on Subcontracting.docx | DOCX document | |
| Comp _ Pen.jpg | JPG image | |
| SOW Comp Pen rev 1.pdf | ||
| 36C24124B0005 0005.docx | DOCX document | |
| 36C24124B0005 0004.docx | DOCX document | |
| Amb Carrier Data.jpg | JPG image | |
| Question and Answers revision 1.pdf | ||
| 36C24124B0005 0003.docx | DOCX document | |
| ParkingMap2020.pdf | ||
| 36C24124B0005 0002.docx | DOCX document | |
| Question and Answers.pdf | ||
| Pre bid sign in sheet 11282023.pdf | ||
| 36C24124B0005 0001.docx | DOCX document | |
| SOW Comp Pen.docx | DOCX document | |
| 36C24124B0005_2.docx | DOCX document | |
| General Decision MA20230001 09152023.pdf |
Show all 17
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Text version
PRE-AWARD CONTRACTOR EVALUATION FORM
COMPLETE & SUBMIT WITH PROPOSAL
(FROM CFM WEBSITE)
Company Name: ______________________________________________
Address: _____________________________________________________
Telephone: ______________________ Fax: ________________________
Email: _______________________________________________________
Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2020 2021 2022 Number of man hours (jobsite and office).
Number of cases involving days away from work, restricted activity, or both (Column H and I of OSHA 300).
Days away, restricted, or transferred rate (# of days away, restricted, or transferred cases x 200,000/# of man hours) (DART Rate).
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 disqualifies the contractor.)
Please attach copies of the following documents: OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page: http://www.osha.gov/pls/publications/publication.html.
2. Provide your six-digit North American Industrial Classification System (NAICS) Code for this acquisition:
3. Who administers your company’s Safety and Health Program? __________________________________
4. Company’s Insurance Experience Modification Rate (EMR) for the past 3 years: _____________
File details come from the government source that posted it. Updated .