36C25621R0108 EXHIBIT D.docx

DOCX document 28 KB Posted

Attached to
Z2DA--520-21-2-7040-0001 Proj No 520-22-161 Wifi Expansion, BXD (VA-21-00048410)
Solicitation number
36C25621R0108
Issued by

About this file

This document contains an exhibit for evaluating contractor safety on a federal construction project. The exhibit requests safety records and insurance information from offerors, including OSHA 300 forms from the past three years, the administrator of the company's safety program, and the current experience modification rate from the offeror's insurance carrier. It also references an associated federal contract opportunity for a WiFi expansion project at the Gulf Coast Veterans Health Care System in Biloxi, Mississippi.

The federal contract opportunity is a 100% set-aside for Service-Disabled Veteran-Owned Small Businesses issued through request for proposal procedures. The project involves providing all labor, materials, tools and equipment for WiFi expansion work with a performance period of 180 days. The estimated value is between $1-2 million. The solicitation number is 36C25621R0108 and will be posted on beta.SAM.gov. Proposals are due around September 1, 2021 with award anticipated within 30 days thereafter. The work location is 400 Veterans Avenue in Biloxi. The NAICS code is 238210 and size standard is $16.5 million. Subcontracting limitations require the prime to perform 15-25% of the cost of the contract with its own employees or other SDVOSBs. Offerors must be verified SDVOSBs registered in the Vendor Information Pages and System for Award Management databases.

View the file

Other files

File Type Posted
36C25621R0108 0004.docx DOCX document
36C25621R0108 0003.docx DOCX document
520 22 161 Pre Award RFI Register 27 Aug 21 v2.docx DOCX document
VHA Directive 1193 COVID 2019 Vaccination August 13 2021.pdf PDF
36C25621R0108 0002.docx DOCX document
36C25621R0108 0001.docx DOCX document
S04 Site Visit Sign-In Sheets - Proj 520-22-161.pdf PDF
36C25621R0108 WD MS20210050 04022021 Mod 2.docx DOCX document
36C25621R0108 SOW.pdf PDF
36C25621R0108 EXHIBIT F.docx DOCX document
36C25621R0108 EXHIBIT C.docx DOCX document
36C25621R0108 ICRA .pdf PDF
36C25621R0108 Complete Drawings .pdf PDF
36C25621R0108 RFP.docx DOCX document
36C25621R0108 EXHIBIT B.docx DOCX document
36C25621R0108 EXHIBIT A.docx DOCX document
36C25621R0108 Complete Specs.pdf PDF
36C25621R0108 EXHIBIT E.docx DOCX document
Show all 18

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

Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 520-22-161 WiFi Expansion 36C25621R0108

Exhibit D 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 .