36C25020B0005-083.docx
DOCX document Posted
- Solicitation number
- 36C25020B0005
About this file
This notice provides information for a federal construction contract opportunity for the Department of Veterans Affairs. The project involves constructing a 6,130 square foot single-story addition atop the Inpatient Bed Tower located on the west elevation of Building 1 at the Cincinnati VA Medical Center to address patient privacy issues on the sixth floor. The estimated value is between $5-10 million and the North American Industry Classification System code assigned is 236220 for Commercial and Institutional Building Construction. Interested Service-Disabled Veteran-Owned Small Businesses should register at SAM.gov as the solicitation documents are expected to be posted around February 26, 2020 at that site. The period of performance is estimated at 780 calendar days. A site visit will also be scheduled.
36C25020B0005 Contractor EMR Certification Form.docx
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Project 539-330:
Company Name: Address: Telephone: Fax: Email: Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2016 |
| 2017 |
| 2018 |
| 2019 |
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
3. Who administers your company’s Safety and Health Program?
4. Company’s Insurance Experience Modification Rate (EMR):
File details come from the government source that posted it. Updated .