36C24920R0008-011.pdf
PDF Posted
- Solicitation number
- 36C24920R0008
About this file
This document contains a pre-solicitation notice for a federal contract opportunity to renovate the clinical lab building at the Memphis VA Medical Center. The renovation project has an estimated value between $5-10 million and will be awarded under FAR Part 15 using a lowest price technically acceptable process. The NAICS code applicable is 236220 and it is a 100% set-aside for service-disabled veteran-owned small businesses. Offerors must be registered in the System for Award Management and Center for Verification and Evaluation databases by the anticipated solicitation release date of November 6, 2019. The pre-award safety evaluation form requests contractors' OSHA record information over the past three years and insurance experience modification rate to determine responsibility prior to award. Questions regarding this opportunity must be submitted in writing to the contracting officer by the anticipated solicitation date.
36C24920R0008 Contractor EMR Certification Form.pdf
View the file
Other files
Show all 46
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Solicitation 36C24920R0008
Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2016 2017 2018
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.
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 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): ____________________________
http://www.osha.gov/pls/publications/publication.html http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .