S02-Attachment 6-Contractor Safety and Environmental Record Evaluation Form 626A4-21-101.pdf

PDF 112 KB Posted

Attached to
Y1DA--36C249-22-AP-3684 - 626A4-21-101 - Renovate & Expand PMRS
Solicitation number
36C24922R0091
Issued by

About this file

Written by GovTribe AI ·

This document contains a pre-solicitation notice and evaluation form for a federal construction contract opportunity. The Department of Veterans Affairs will issue a request for proposals on or about August 24, 2022 for construction services to renovate and expand the Physical Medicine Rehabilitation Services at the Alvin C. York VA Medical Center in Murfreesboro, Tennessee. The magnitude of construction is estimated between $2 million and $5 million. The NAICS code for this acquisition is 236220 for commercial and institutional building construction. The acquisition is set aside 100% for verified Service-Disabled Veteran-Owned Small Businesses. The evaluation form requests safety and compliance documentation from interested contractors.

View the file

Other files

File Type Posted
Amendment 0005 Corrected Room Numbers.pdf PDF
Amendment 0005-Renovate and Expand PMRS 36C24922R0091.pdf PDF
S06-Amendment 0004-Renovate and Expand PMRS-36C24922R0091.pdf PDF
S06 - Amendment 0003 - Renovate and Expand PMRS.pdf PDF
36C24922R0091 Amendment 0002 Pre-Bid RFI Answers 1-36.pdf PDF
36C24922R0091 Amendment 0002 RFI Reno PMRS Attachment.pdf PDF
Amendment 0001.pdf PDF
Amendment 0001 PreBid Sign in sheet 626A4-21-101.pdf PDF
S02-Attachment 2-PMRS Final Bid Set Drawings-626A4-21-101.pdf PDF
S02-Attachment 5-Past Performance Questionnaire-626A4-21-101.pdf PDF
S02-Attachment 4-Wage Determination TN20210187-09-02-2022-Rutherford County.pdf.pdf PDF
Solicitation 36C24922R0091 09122022.pdf PDF
S02-Attachment 1-PMRS Pricing Schedule-626A4-21-101.xlsx XLSX spreadsheet
S02-Attachment 3- PMRS Final Bid Set Specs-626A4-21-101.pdf PDF
36C24922R0091.docx DOCX document
Show all 15

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

Pre-Award Contractor Safety and Environmental Record Evaluation Form

Information provided below is current and applicable to Solicitation 36C24922R0091

Company Name:

Address:

Telephone:

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: 236220 – Commercial and Institutional Building Construction

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 .