S02 PRE-AWARD CONTRACTOR EVALUATION FORM.pdf
PDF 135 KB Posted
- Solicitation number
- 36C24124B0041
About this file
The document provided is a Pre-Award Contractor Evaluation Form that is required to be completed and submitted with a proposal for the federal contract opportunity.
The form collects information on the company's safety performance, including OSHA 300 incident data, safety and health program administration, and the company's Experience Modification Rate (EMR) for the past three years. This information is used to evaluate the contractor's safety record prior to award. The form also requires the contractor to provide their six-digit NAICS code.
The related federal contract opportunity is for the Construction of Building 78 Roof Replacement, solicited by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 1. The solicitation number is 36C24124B0041. No additional details on the scope of work, response dates, award dates, pricing terms, or set asides are provided.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24124B0041 0008.docx | DOCX document | |
| SF_1409 - 36C24124B0041 - 518-21-118.pdf | ||
| 36C24124B0041 0007.docx | DOCX document | |
| 36C24124B0041 0006.docx | DOCX document | |
| Bldg 78 Roof - April 1st Site Visit sign in.pdf | ||
| 36C24124B0041 0005.docx | DOCX document | |
| 36C24124B0041 0004.docx | DOCX document | |
| pre-bid site walkthrough sign in.pdf | ||
| 36C24124B0041 0003.docx | DOCX document | |
| 36C24124B0041 0002.docx | DOCX document | |
| Instructions to Bidders - 36C24124B0041 - Building 78 Roof.pdf | ||
| 36C24124B0041 0001.docx | DOCX document | |
| Davis-Bacon Act WD MA20240001 revised 020924.pdf | ||
| 518-21-118 Building 78 Roof Replacement - SPECIFICATIONS - Bid.pdf | ||
| 518-21-118 Building 78 Roof Replacement - Plans BID Set.pdf | ||
| 36C24124B0041_2.docx | DOCX document | |
| 518-21-118 Building 78 Roof Replacement - Scope of Work.docx | DOCX document |
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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 2021 2022 2023 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 .