36C25020B0008-009.docx

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Expand East Parking 610-312
Solicitation number
36C25020B0008
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This document contains a contractor certification form and information about a federal contract opportunity to expand parking at the Fort Wayne VA Medical Center. The contractor certification form requests information about any OSHA violations in the past three years, the company's current insurance EMR rate, and requires a signature.

The federal contract opportunity is to demolish an existing house and build a parking lot. It will be procured as a 100% set aside for SDVOSBs, with a NAICS code of 236220 and magnitude between $500,000-$1,000,000. The solicitation number is 36C25020B0008 and will be issued on FEDBIZOPPS.gov on or around December 20, 2019. A pre-solicitation site visit will be scheduled. The point of contact is Nathan Heikkinen of the VA Northern Indiana Health Care System NCO 10 Contracting Office, who can be reached by phone or email.

36C25020B0008 Contractor Certification Regarding Safety and Environmental.docx

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Contractor Certification Regarding Project: 610-312

2017
2018
2019

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 .