36C25621R0122 EXHIBIT D.docx
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- Solicitation number
- 36C25621R0122
About this file
This document includes an exhibit for evaluating contractor safety on a federal construction contract opportunity to renovate a cath lab at the Overton Brooks VA Medical Center. The contract opportunity is a 100% set-aside for Service-Disabled Veteran-Owned Small Businesses. The exhibit requests contractors to provide OSHA 300 forms from 2018 to 2020 with man-hours and incident details, explanations for any serious violations, and insurance experience modification rates. Contractors must also identify who administers their safety program. The related federal contract opportunity notices the tentative dates as August 2nd, 2021 for issuing the RFP and September 1st, 2021 for proposals due. The anticipated award date is 30 days after receipt of proposals. The performance period is 808 calendar days after notice to proceed. The location is the Overton Brooks VA Medical Center. The NAICS code is 236220 and size standard is $39.5 million. The construction cost range is $2-5 million.
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FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 667-15-104 Renovate Cath Lab, 6E 36C25621R0122
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 .