S02 Contractor EMR Certification Form 2021 515-21-104.pdf
PDF 165 KB Posted
- Attached to
- Z1DZ--Replace Roofs, Various Buildings, Phase II 515-21-104 Federal contract opportunity
- Solicitation number
- 36C25022B0027
About this file
This document contains a pre-solicitation notice and evaluation form for a federal contract opportunity. The Department of Veterans Affairs intends to advertise for bids to replace roofs on six buildings at the Battle Creek Veterans Medical Center in Michigan. Work includes furnishing all labor, tools, materials, equipment and supervision to accomplish roof replacements within 240 calendar days. The NAICS code is 238160 for roofing contractors with a small business size standard of $16.5 million. The estimated value is between $1,000,000 to $5,000,000. The government intends to award a firm fixed price contract within 120 days of bid opening. This opportunity is reserved solely for verified Service-Disabled Veteran Owned Small Businesses registered in the Vendor Information Pages database. The evaluation form requests safety records and insurance information from prospective contractors.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Notice of Award - Contract 36C25022C0218 Project 515-21-104.pdf | ||
| 515-21-104 Bid Drawings - Full Set.pdf | ||
| S02 - RFI Form 515-21-104.pdf | ||
| 36C25022B0027.pdf | ||
| 515-21-104 Bid Specifications - Full Set.pdf | ||
| Davis-Bacon Act WD MI20220079 Mod 4 - 06-24-2022 Calhoun County.pdf | ||
| 36C25022B0027_1.docx | DOCX document |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Solicitation 36C25022B0027 Company Name: ______________________________________________ Address:
_____________________________________________________ Telephone:
______________________ Fax: ________________________ Email: _______________________________________________________ Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2019 2020 2021
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: __________________________________
3. Who administers your company’s Safety and Health Program? _____________________
4. Company’s Insurance Experience Modification Rate (EMR): ______________________ http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .