EXHIBIT C CONTRACTOR EVALUATION FORM CONSTRUCTION SAFETY v2.docx
DOCX document 27 KB Posted
- Solicitation number
- 36C25621R0012
About this file
This document contains an exhibit for evaluating contractor safety performance on construction projects for the federal government. It requests safety-related information from contractors, including OSHA forms, injury rates, violations, and insurance details. Contractors must submit their company's safety program administration and current experience modification rate from their insurance carrier.
A related federal contract opportunity involves correcting fire alarm deficiencies for the Veterans Health Care System of the Ozarks. The solicitation will be a 100% set-aside for service-disabled veteran-owned small businesses as a request for proposal. Interested offerors should check the SAM website for the RFP release on or around October 16, 2020, with proposals due on or around November 30, 2020. The anticipated award date is approximately 30 days after receipt of proposals. The contract performance period will be 240 calendar days with work located at the facility in Fayetteville, Arkansas. Offerors must be registered and verified as a service-disabled veteran-owned small business in the Vendor Information Pages database and System for Award Management to be considered.
View the file
Other files
Show all 29
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
FOR OFFICIAL USE ONLY
Exhibit C Contractor Evaluation Form Construction Safety
Company Name:
Address:
Telephone: Fax:
Email:
Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2018 |
| 2019 |
| 2020 |
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 explanations 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. | Who administers your company’s Safety and Health Program? |
| 3. | Company’s current Insurance Experience Modification Rate (EMR): |
The above EMR rate must be obtained from offeror’s insurance carrier and furnished on insurance carrier’s letterhead. If EMR is greater than 1.0, attach a written explanation of the EMR from insurance carrier on insurance carrier’s letterhead describing the reasons for the EMR and the anticipated date the EMR may be reduced to 1.0 or below.
File details come from the government source that posted it. Updated .