EMR 36C24922R0038.pdf
PDF 141 KB Posted
- Solicitation number
- 36C24922R0038
About this file
This document contains a pre-award contractor safety and environmental record evaluation form and information on a related federal contract opportunity for renovation work. The evaluation form requests safety-related information including man hours, OSHA recordable incidents, and insurance experience modification rate. The federal contract opportunity is to renovate a women's health clinic building at the James H. Quillen VA Medical Center in Mountain Home, Tennessee. It is a 100% set-aside for service-disabled veteran-owned small businesses. The estimated contract value is between $1,000,000 and $2,000,000. The solicitation is expected to be issued on or around March 9th, 2022 and close on or around April 8th, 2022. The awarded contractor must be verified in the Center for Verification and Evaluation database and have an active System for Award Management registration.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24922R0038 0002.pdf | ||
| Price Proposal Template.xlsx | XLSX spreadsheet | |
| 36C24922R0038 0001.pdf | ||
| 36C24922R0038_1.pdf | ||
| PPQ - Project 621-17-110.pdf | ||
| General Conditions Breakout.xlsx | XLSX spreadsheet | |
| Drawing Set.pdf | ||
| WD TN20220111 2-25-22.pdf | ||
| Specs Combined Set.pdf | ||
| RFI Form - 36C24922R0038.pdf | ||
| 36C24922R0038.docx | DOCX document |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Solicitation: 36C24922R0038 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.
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
File details come from the government source that posted it. Updated .