EXHIBIT C CONTRACTOR EVALUATION FORM CONSTRUCTION SAFETY v2.docx
DOCX document 27 KB Posted
- Attached to
- Z2NB--564-21-1-609-0001 Install Catwalks & Upgrade Piping System Boiler Plant B-10 (564-14-124)
- Solicitation number
- 36C25621R0020
About this file
This document includes an exhibit for evaluating construction contractor safety and a federal contract opportunity for upgrading systems at a Veterans Health Care facility. The exhibit outlines safety metrics contractors must provide including man-hours, OSHA recordable incidents, rates, violations, and insurance ratings. Contractors must also identify their safety program administrator and explain above-average insurance modification rates.
The federal contract opportunity will be issued as a 100% small business set-aside through an RFP for a Service-Disabled Veteran-Owned Small Business to install catwalks and upgrade piping systems at a Veterans facility. The RFP is expected to publish in January 2021 with proposals due in February and award by March. Work must be completed within one year of the notice to proceed. Interested parties must register in the Vendor Information Pages and System for Award Management databases and have a Center for Veterans Enterprise verification. The Department of Veterans Affairs Veterans Health Administration is the contracting agency.
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| File | Type | Posted |
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| 36C25621R0020 0004 .docx | DOCX document | |
| COMPLETE RFI RESPONSES.docx | DOCX document | |
| 36C25621R0020 0003.docx | DOCX document | |
| VA-Soils Report.pdf | ||
| Parking Plan Visual with Boiler laydown.pdf | ||
| GC101 Updated.pdf | ||
| E-601 Updated.pdf | ||
| Lead Report.pdf | ||
| Asbestos Report.pdf | ||
| SITE VISIT SIGN IN SHEET.pdf | ||
| RFI RESPONSES.docx.doc | DOC document | |
| AMENDMENT TO RESCHEDULE SITE VISIT - 36C25621R0020 0002.docx | DOCX document | |
| AMENDMENT TO RESCHEDULE SITE VISIT - 36C25621R0020 0001.docx | DOCX document | |
| 36C25621R0020 0001.docx | DOCX document | |
| 564-14-124 - Construction Specifications.pdf | ||
| 564-14-124 Construction Drawings.pdf | ||
| SOLICITATION 36C25621R0020_1.docx | DOCX document | |
| Current Parking Plan.pdf | ||
| WAGE DETERMINATION AR20210035 01-01-2021.pdf | ||
| EXHIBIT A PERFORMANCE RELEVANCY SURVEY v2.docx | DOCX document | |
| EXHIBIT B Past and Present Performance Questionnaire.docx | DOCX document | |
| 36C25621R0020.docx | DOCX document |
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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 .