36C25622R0002 EXHIBIT D.docx
DOCX document 28 KB Posted
- Solicitation number
- 36C25622R0002
About this file
This document includes a solicitation for elevator repair services at a Veterans Affairs health care facility, along with an evaluation form for contractor safety programs. The solicitation seeks bids to repair five elevators at the Alexandria VA Health Care System in Pineville, Louisiana, with a construction cost range of $500,000 to $1,000,000. Interested Service-Disabled Veteran-Owned Small Businesses must be registered in the System for Award Management and Vendor Information Pages databases. The completed solicitation will be issued on September 6, 2021 via Beta.SAM.gov. The evaluation form requests contractors to provide OSHA recordable incident data and insurance experience modification rates, and to identify their safety program administrator. Submitted documentation must include OSHA Forms 300 and 300A along with explanations for any serious violations.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 36C25622R0002 Revised SOW.docx | DOCX document | |
| 36C25622R0002 0002.docx | DOCX document | |
| 36C25622R0002 Pre-Award RFI Register .docx | DOCX document | |
| 502 21 700 Sign in Sheet.pdf | ||
| 36C25622R0002 0001.docx | DOCX document | |
| 36C25622R0002 Elevators 4 and 5 v4.pdf | ||
| 36C25622R0002 Elevator Layout 4 and 5.pdf | ||
| 36C25622R0002 Elevators 4 and 5 v3.pdf | ||
| 36C25622R0002 EXHIBIT F.docx | DOCX document | |
| 36C25622R0002 WDLA20200051 Mod 2 06182021.pdf | ||
| 36C25622R0002 Elevators 4 and 5.pdf | ||
| 36C25622R0002 EXHIBIT C.docx | DOCX document | |
| 36C25622R0002 EXHIBIT E.docx | DOCX document | |
| 36C25622R0002 Elevators 4 and 5 v2.pdf | ||
| 36C25622R0002 Elevator 3.pdf | ||
| 36C25622R0002 Existing Conditions.pdf | ||
| 36C25622R0002 RFP.docx | DOCX document | |
| 36C25622R0002 SOW .docx | DOCX document | |
| 36C25622R0002 EXHIBIT A.docx | DOCX document | |
| 36C25622R0002 EXHIBIT B.docx | DOCX document | |
| 36C25622R0002 Elevator 1 and 2.pdf | ||
| 36C25622R0002 Specifications Repair Elevators.docx | DOCX document |
Show all 22
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. 502-21-700 Repair of Elevator Nos. 1, 2, 3, 4 & 5 for BLDG 7 36C25622R0002 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 .