ATTACHMENT C - EMR.pdf
PDF 188 KB Posted
- Solicitation number
- 36C24825R0010
About this file
This document is an EMR (Experience Modification Rate) form for bidders/offerors to complete and submit with their proposal for a federal contract opportunity.
The key details are:
- The contract opportunity is for Design-Build (DB) services to upgrade the Lake Nona Endoscopy Rooms at the Department of Veterans Affairs (VA) Orlando Medical Center.
- The contract opportunity is a two-phase design-build procurement with a trade-off source selection process, with the period of performance being 420 calendar days after the Notice to Proceed.
- The contract is set-aside for Service-Disabled Veteran-Owned Small Businesses (SDVOSB), with a NAICS code of 236220 (Commercial and Institutional Building Construction) and a magnitude between $2,000,000 and $5,000,000.
- The EMR form requires bidders to provide information from their OSHA 300 forms, including number of man-hours, cases involving days away from work, DART rate, and any OSHA violations. Bidders must also provide their six-digit NAICS code, details on who administers their safety and health program, and their EMR for the past 3 years (an EMR greater than 1.0 disqualifies the contractor).
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24825R0010 0002.docx | DOCX document | |
| 36C24825R0010 0001.docx | DOCX document | |
| ATTACHMENT D - Experience Information Sheet.pdf | ||
| ATTACHMENT F - Limitation of Subcontracting Certificate.pdf | ||
| ATTACHMENT E - Past Performance Questionnaire.docx | DOCX document | |
| ATTACHMENT B - Contract Progress Schedule.docx | DOCX document | |
| Solicitation 36C24825R0010.pdf | ||
| ATTACHMENT A - Davis-Bacon Act Wage Determination.pdf |
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Text version
EMR FORM
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 2020 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 (an EMR of greater than 1.0 disqualifies the contractor): _____________ http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .