Contractor Certification Regarding Safety and Environmental.docx
DOCX document 13 KB Posted
- Attached to
- Z1DA--Correct OIT Deficiencies 610A4-16-101 SB Federal contract opportunity
- Solicitation number
- 36C25020B0037
About this file
This document is a contractor certification form regarding safety and environmental compliance for Project 610A4-16-101. The form requests information on any serious, willful, or repeat OSHA violations from the last three years and the contractor's current insurance EMR rating, to be supported by a signed letter from their insurance carrier. A signature and contact information are also required.
The related federal contract opportunity is a pre-solicitation notice for Solicitation Number 36C25020B0037 to correct deficiencies at OIT for Project 610A4-16-101. The opportunity is being issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Drawings 9 of 11.pdf | ||
| Drawings 8 of 11.pdf | ||
| Drawings 4 of 11.pdf | ||
| Wage Determination IN20200002 04032020.pdf | ||
| Drawings 11 of 11.pdf | ||
| RFI Form.doc | DOC document | |
| Drawings 10 of 11.pdf | ||
| Specifications.pdf | ||
| Drawings 2 of 11.pdf | ||
| Drawings 7 of 11.pdf | ||
| Drawings 6 of 11.pdf | ||
| Drawings 3 of 11.pdf | ||
| Drawings 1 of 11.pdf | ||
| 36C25020B0037_final.pdf | ||
| 36C25020B0037_1.docx | DOCX document |
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Text version
Contractor Certification Regarding Project: 610A4-16-101
| 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 .