36C25019B0022-007.docx
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- Attached to
- 4th Floor Pharmacy HVAC Construction Project no. 539-18-501 Federal contract opportunity
- Solicitation number
- 36C25019B0022
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36C25019B0022 Attach 5 Contractor Certification Regarding EMR.docx
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Contractor Certification Regarding Project: 539-18-202
| 2013 |
| 2014 |
| 2015 |
| 2016 |
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 violation could result in being determined non-responsible.)
Company’s Current Insurance Experience Modification Rate (EMR) = _____________ (Note: Contractor must support the EMR with a signed letter from Insurance Carrier on their letterhead.)
Signature: ______________________________________________
Typed Name: ______________________________________________________
Title: ______________________________________________________
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