S02 SOL_Att08 Contractor Safety and EMR.docx
DOCX document 20 KB Posted
- Solicitation number
- 36C25227R0001
About this file
This is a Pre-Award Contractor Safety and Environmental Record Evaluation Form included as Solicitation Attachment 1 for MATOC 36C25227R0001, a bathroom renovation project at the VA Illiana Health Care System in Danville, Illinois. All bidders and offerors must submit comprehensive safety and environmental compliance documentation, including certification that they have no more than three serious OSHA violations, one repeat violation, or one willful violation from OSHA or EPA within the past three years. If this certification cannot be made, contractors must provide detailed explanations of violations. Additionally, all bidders must submit their current Experience Modification Rate (EMR) on their insurance carrier's letterhead; if the EMR exceeds 1.0, contractors must provide a written explanation from their carrier detailing reasons for the elevated rate and the anticipated timeline for reduction to 1.0 or below. Self-insured contractors and those unable to obtain EMR ratings from standard insurance carriers must obtain ratings from the National Council on Compensation Insurance, Inc. (NCCI) using form ERM-6, or from their respective state worker's compensation rating bureaus for specified states including California, Delaware, Michigan, New Jersey, North Dakota, Ohio, Pennsylvania, Washington, Wyoming, and Puerto Rico.
The evaluation form requires contractors to complete detailed information including their OSHA 300 and 300a forms covering 2023 through 2025, with specific data on man-hours, DART rates, and serious or willful violations. Contractors must identify their six-digit NAICS code (236220 for this acquisition), the administrator of their Safety and Health Program, and their company's EMR. This requirement applies to all subcontracting tiers, making prime contractors responsible for verifying the responsibility of prospective subcontractors. The submitted information, combined with Government review of OSHA and EPA online inspection history databases, will be used to make initial determinations of contractor responsibility.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| S02 SOL_Att07_SEED PROJECT WD IL20250002 05.1.2026.pdf | ||
| S02 SOL_Att05 SEED PROJECT Specs.pdf | ||
| S02 SOL_Att04 Past Performance Client Questionnaire.docx | DOCX document | |
| S02 SOL_Att01_SEED PROJECT SOW Renovate Bathrooms B103 RRTP.pdf | ||
| S02 SOL_Att02 Contractor General Information.docx | DOCX document | |
| 36C25227R0001_2.docx | DOCX document | |
| S02 SOL_Att06 SEED PROJECT Drawings.pdf | ||
| S02 SOL_Att09 VAAR 852.219-75 Certification 550-MATOC.docx | DOCX document | |
| S02 SOL_Att03 Sub-contractor Info Consent.docx | DOCX document |
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Multiple Award Task Order Contract (MATOC) 36C25227R0001 Solicitation Attachment 1 Safety or Environmental Violations and Experience Modification Rate
All Bidders/Offerors shall submit information pertaining to their past Safety and Environmental record. The information must contain a certification that the bidder/offeror has no more than three (3) serious, or one (1) repeat or one (1) willful OSHA or any EPA violation(s) in the past three years. If such certification cannot be made, a Bidder/Offeror shall explain why and submit as much information as possible regarding the circumstances of its past safety and environmental record, including the number of EPA violations and/or the number of serious, repeat, and/or willful OSHA violations, along with a detailed description of those violations.
All Bidders/Offerors shall submit information regarding their current Experience Modification Rate (EMR). This information shall be obtained from the Bidder’s/Offeror’s insurance carrier and be furnished on the insurance carrier’s letterhead. If a Bidder/Offeror’s EMR is above 1.0, Bidder/Offeror must submit a written explanation of the EMR from its insurance carrier furnished on the insurance carrier’s letterhead, describing the reasons for the EMR, and the anticipated date the EMR may be reduced to 1.0 or below.
Self insured contractors or other contractors that cannot provide their EMR rating on insurance letterhead must obtain a rating from the National Council on Compensation Insurance, Inc. (NCCI) by completing/submitting form ERM-6 and providing the rating on letterhead from NCCI. Note: Self insured contractors or other contractors that cannot provide EMR rating on insurance letterhead from the states or territories of CA, DE, MI, NJ, ND, OH, PA, WA, WY, and PR shall obtain their EMR rating from their state run worker’s compensation insurance rating bureau.
If the NCCI cannot issue an EMR because the Bidder/Offeror lacks insurance history, Bidder/Offeror shall submit a letter indicating so from its insurance carrier furnished on the insurance carrier’s letterhead, and include a letter from the NCCI indicating that is has assigned Bidder/Offeror a Unity Rating of 1.0.
The above information, along with other information obtained from Government systems, such as the OSHA and EPA online inspection history databases, will be used to make an initial Determination of Responsibility.
This requirement is applicable to all subcontracting tiers, and prospective prime contractors are responsible for determining the responsibility of their prospective subcontractors.
Solicitation Attachment 1 Revision 1 Safety or Environmental Violations and Experience Modification Rate
Pre-Award Contractor Safety and Environmental Record Evaluation Form Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2023 |
| 2024 |
| 2025 |
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 your 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): _____________ |
File details come from the government source that posted it. Updated .