36C25020B0017-011.docx

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Z1DA--Demolish Multiple Buildings (Marion) Project 610-19-201
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36C25020B0017
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This document contains a presolicitation notice and contractor certification form for a demolition project at the VA Northern Indiana Health Care System campus in Marion, Indiana. The Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10 will solicit bids to demolish and remove buildings 35, 36, 37, 38, 75, 94, 95, 96, 118 and 149. The contractor will be responsible for asbestos and lead paint abatement, utility disconnect, removal of roads and driveways, removal of trees and buildings including foundations and slabs, backfilling, grading and seeding. All items removed must be disposed of by the contractor. The work must be completed in accordance with contract drawings and specifications. This project is set aside solely for Service Disabled Veteran-Owned Small Businesses. Bids are due on or around January 31, 2020 via the System for Award Management. A pre-solicitation site visit will be scheduled. The point of contact is Jeff Hairston, who can be reached by email or phone. The contractor certification form requests information on the bidder's OSHA violations and insurance experience modification rate.

36C25020B0017 Contractor Certification Regarding Safety and Environmental.docx

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Contractor Certification Regarding Project: 610-19-201

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: ______________________________________________________

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