S02 Contractor EMR Certification Form 2021_515-21-105.pdf
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- Attached to
- Z1DA--Upgrade Physical Security, Campus Wide 515-21-105 Federal contract opportunity
- Solicitation number
- 36C25022B0044
About this file
This pre-solicitation notice announces the Department of Veterans Affairs' intent to issue an invitation for bid for upgrading physical security deficiencies across the Battle Creek Veterans Administration Medical Center campus located in Battle Creek, Michigan. The project scope includes upgrading campus security based on new VA physical security guidelines covering multiple buildings and exterior areas, as well as constructing a new permanent guard shelter. The period of performance is 420 calendar days with a cost between $1,000,000 and $5,000,000. The solicitation will be issued on May 27, 2022 via the Contract Opportunities website and only offers from verified Service-Disabled Veteran Owned Small Businesses registered in the Vendor Information Pages database will be considered responsive. The award is intended within 120 days of bid opening with a firm fixed price contract.
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Solicitation 36C25022B0044 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 .