S02 Contractor EMR Certification Form - 515-21-101.docx
DOCX document 15 KB Posted
- Attached to
- Z1DA--HVAC Upgrades Phase II 515-21-101 Federal contract opportunity
- Solicitation number
- 36C25023B0045
About this file
This pre-solicitation notice provides details for an upcoming Invitation for Bid for HVAC upgrades at a VA medical center. The Department of Veterans Affairs intends to issue an IFB on or around May 12, 2023 for furnishing labor, materials, equipment, and supervision to complete HVAC upgrades at the VA Medical Center in Battle Creek, Michigan. The work is to be performed during normal business hours excluding federal holidays. The NAICS code for this procurement is 238220 with a small business size standard of $19 million. The government estimates the cost to be between $2-5 million and intends to award a firm fixed price contract within 120 days of bid opening. This acquisition is set aside 100% for qualified Service-Disabled Veteran Owned Small Businesses. Offerors must register in SAM.gov and VetCert and have a current VETS-4212 report on file if applicable. All questions must be submitted in writing to the specified contracting officer by the specified deadline.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| C08 Notice of Award email - Robbert Constr - 515-21-101.pdf | ||
| S06 36C25023B0045 0002 - 515-21-101.pdf | ||
| 515-21-101 Addendum 002.pdf | ||
| S06 Pre-Bid Site Visit Agenda - 515-21-101.pdf | ||
| S06 515-21-101 Addendum Dwgs.pdf | ||
| S06 02 82 11 - Traditional Asbestos Abatement.pdf | ||
| S06 515-21-101 Addendum 001.pdf | ||
| S06 36C25023B0045 0001 - 515-21-101.pdf | ||
| S06 Pre-bid attendance - 515-21-101.pdf | ||
| S06 01 35 26 - Safety Requirements.pdf | ||
| S02 Wage Determination - MI20230079 - 5-5-23 - Calhoun - 515-21-101.pdf | ||
| S02 36C25023B0045_1 - 515-21-101.pdf | ||
| S02 Wage Determination - MI20230079 - 5-5-23 - Calhoun - 515-21-101.pdf | ||
| S02 Drawings - 515-21-101.pdf | ||
| S02 RFI Form - 515-21-101.doc | DOC document | |
| S02 Specifications - 515-21-101.pdf | ||
| 36C25023B0045.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 36C25023B0045 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 .