S02 Contractor EMR Certification Form - 553-20-101.docx
DOCX document 15 KB Posted
- Attached to
- Z1DA--Elevator Replacement Building 100 553-20-101 Federal contract opportunity
- Solicitation number
- 36C25023B0006
About this file
This notice provides details for an upcoming elevator replacement project at a Department of Veterans Affairs medical center. The Department of Veterans Affairs intends to issue an Invitation for Bid on or around November 30th, 2022 for Project 553-20-101 to replace elevators in Building 100 at the John D. Dingell Veterans Administration Medical Center located in Detroit, Michigan. The project has an estimated cost between $5-10 million and will utilize NAICS code 238290 for other building equipment contractors with a small business size standard of $19.5 million. The solicitation will be available on SAM.gov and the contract will have a 120 day award period and utilize a firm fixed price contract type. This acquisition is reserved exclusively for Service-Disabled Veteran Owned Small Businesses. All prospective contractors must be registered in the systems specified prior to bid submission.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| C08 Notice of Award - 553-20-101 - signed.pdf | ||
| S06 36C25023B0006 0003 - 553-20-101.pdf | ||
| S06 Hatch Steel Beam.jpg | JPG image | |
| S06 Hatch In Interstitial.jpg | JPG image | |
| S06 Hatch Picture.jpg | JPG image | |
| S06 36C25023B0006 0002 - 553-20-101.pdf | ||
| S06 36C25023B0006 0001 - 553-20-101.pdf | ||
| S06 Wage Determination - MI - Wayne Co - MI20230101 - 01-06-23 - 553-20-101.pdf | ||
| S06 Pre-Bid Site Visit Agenda - 553-20-101.pdf | ||
| S06 Pre-Bid Site Visit Attendance Log - 553-20-101.pdf | ||
| S02 36C25023B0006_1 - 553-20-101.pdf | ||
| S02 Wage Determination - MI - Wayne Co - MI20220101 - 09-16-22 - 553-20-101.pdf | ||
| S02 RFI Form - 553-20-101.doc | DOC document | |
| S02 Drawings - 553-20-101.pdf | ||
| S02 Specifications Vol II - 553-20-101.pdf | ||
| S02 Specifications Vol I - 553-20-101.pdf | ||
| 36C25023B0006.docx | DOCX document |
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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 36C25023B0006 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 |
| 2020 |
| 2021 |
| 2022 |
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) 2020 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): ______
File details come from the government source that posted it. Updated .