S02 - Contractor EMR Certification Form -506-21-205.pdf
PDF 140 KB Posted
- Attached to
- Z1DA--Renovate 9th Floor East Wing 506-21-205
- Solicitation number
- 36C25022B0063
About this file
This pre-solicitation announcement provides details for an upcoming Invitation for Bid for renovation services at a Veterans Affairs medical center. The Department of Veterans Affairs intends to solicit bids for project 506-21-202 to renovate the 9th floor east wing at the LTC Charles S Kettles Veterans Administration Medical Center located in Ann Arbor, Michigan. The solicitation will be issued on or around July 11, 2022 seeking bids for all necessary labor, materials, equipment, and supervision to complete the renovation as specified in the drawings and specifications. The work must be performed in compliance with manufacturer recommendations and applicable codes and standards during normal business hours excluding federal holidays. The North American Industry Classification Code for this procurement is 236220 for Commercial and Institutional Building Construction, with a small business size standard of $39.5 million. The estimated cost of the project is between $1,000,000 and $2,000,000. The government intends to award a firm fixed price contract within 120 days of bid opening. This acquisition is reserved solely for qualified Service-Disabled Veteran Owned Small Businesses.
View the file
Other files
Show all 22
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Pre-Award Contractor Experience Modification Rate (EMR) Form
Information regarding your EMR is being sought in conjunction with your offer applicable to Solicitation 36C25022B0063 to assist in making an initial determination of responsibility for any potential awardee in accordance with FAR 9.104-1(e) which states that “to be determined responsible, a prospective contractor must have the necessary organization, experience, accounting and operational controls, and technical skills including safety programs applicable to materials to be produced or services to be performed by the prospective contractor and subcontractors.”
Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information for the past three calendar years:
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.
2. Please attach copies of the following documents: a)2019 OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page: http://www.osha.gov/pls/publications/publication.html. b)Letter from insurance carrier stating current EMR rate.
3. Provide six-digit North American Industrial Classification System (NAICS) Code for this acquisition: __________________________________
4. The name and title of the person who administers your company’s Safety and Health Program? ____________________________.
5. Your 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 .