EXHIBIT C CONTRACTOR EVALUATION FORM CONSTRUCTION SAFETY v2.docx
DOCX document 27 KB Posted
- Attached to
- Renovate B9 Laundry Federal contract opportunity
- Solicitation number
- 36C25621R0052
About this file
This document contains an exhibit for evaluating contractor safety on construction projects and details for a related federal contract opportunity to renovate a laundry facility. The evaluation exhibit includes forms for recording contractor safety metrics like man-hours worked, OSHA recordable incidents, injury rates, and violations. It requests documentation of the company's safety program and insurance experience modification rate.
The federal contract opportunity is a 100% set-aside for service-disabled veteran-owned small businesses to renovate the laundry facility at a Veterans Health Administration medical center. The renovation project is estimated to cost between $2-5 million. The solicitation number is provided, along with anticipated dates for issuing the request for proposals, proposal receipt, contract award, and completing the 365-day period of performance. Requirements include all labor, materials and equipment to complete the scope of work, drawings and specifications. The NAICS code and size standard are specified.
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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 .