36C25019B0048-017.docx
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- Attached to
- Expand Engineering Support Space 539-19-201 Federal contract opportunity
- Solicitation number
- 36C25019B0048
About this file
This document contains a contractor certification form and details of a federal contract opportunity notice for expanding engineering support space at the Veterans Administration Cincinnati VA Medical Center. The contractor certification form requests information on any OSHA violations in the past three years and the company's current insurance experience modification rate.
The federal contract opportunity is a 100% set-aside for small businesses with a preference for veteran-owned small businesses. It involves a project to expand engineering support space at the Cincinnati VAMC with a magnitude between $500,000 and $1,000,000. Interested vendors must register on the Vendor Information Pages and SAM websites. The solicitation will be released on or around September 27, 2019, with the NAICS code 236220 and business size standard of $36.5 million. The selected contractor must be able to provide safety/environmental violation details and an experience modification rate of 1.0 or less. The project duration shall not exceed 275 calendar days from receipt of the notice to proceed. Bonds will be required in the form of bid, payment, and performance bonds. The soliciting agency is the Department of Veterans Affairs Veterans Health Administration VISN 10.
36C25019B0048 Attach 5 Contractor Certification Regarding EMR 02.docx
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Text version
Contractor Certification Regarding Project: 539-18-202
| 2016 |
| 2017 |
| 2018 |
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: ______________________________________________________
File details come from the government source that posted it. Updated .