S02 - ATTACHMENT 3 - EMR (1 PAGE).docx
DOCX document 14 KB Posted
- Solicitation number
- 36C24822R0125
About this file
This document contains an EMR form for bidders to complete and submit with proposals for a federal contract opportunity. The form requests company information including number of man hours, OSHA recordable cases from 2019 to 2021, DART rates for those years, and any serious, willful, or repeat OSHA violations from the past three years. Bidders must attach copies of their OSHA 300 and 300A forms as well as provide their six-digit NAICS code and insurance experience modification rate for the past three years, with any rate over 1.0 disqualifying the contractor.
The related federal contract opportunity is a pre-solicitation to correct NEC deficiencies and infrastructure at Building 44 for the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8. Bidders are required to complete the EMR form and submit it along with any proposal for this opportunity to renovate a Veterans Affairs building.
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Other files
| File | Type | Posted |
|---|---|---|
| ISSUED FOR CONSTRUCTION - Specs 2022 03 23 (1).pdf | ||
| ISSUED FOR CONSTRUCTION - Dwgs 2022 03 23.pdf | ||
| 36C24822R0125 0004_1.docx | DOCX document | |
| 36C24822R0125 0003_1.docx | DOCX document | |
| 36C24822R0125 0002_1.docx | DOCX document | |
| 36C24822R0125 0001_1.docx | DOCX document | |
| S02 - ATTACHMENT 5 - SPECIALIZED EXPERIENCE FROM.pdf | ||
| S02 Attachment 8 drawings - 546 21 102 Correct NEC Deficiencies Final Submittal.pdf | ||
| S02 Attachment 6 - 546 2 1 102 Site Plan.pdf | ||
| 36C24822R0125_2.docx | DOCX document | |
| Attachment 1 - Wage Determination.pdf | ||
| S02 - ATTACHMENT 4- PAST PERFORMANCE QUESTIONNAIRE.pdf | ||
| S02 ATTACHMENT 2- PRICE MATRIX.xlsx | XLSX spreadsheet | |
| S02 Attachment 7 - 546 21 102 Correct NEC Deficiencies Final Submittal App.pdf | ||
| 36C24822R0125.docx | DOCX document |
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Text version
EMR FORM FOR BIDDER/OFFEROR TO COMPLETE & SUBMIT WITH PROPOSAL
Pre-Award Contractor Evaluation Form Company Name: ______________________________________________
Address: _____________________________________________________
Telephone: ______________________ Fax: ________________________
Email: _______________________________________________________
Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2019 |
| 2020 |
| 2021 |
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 (an EMR of greater than 1.0 disqualifies the contractor): _____________
File details come from the government source that posted it. Updated .