EXHIBIT D CONTRACTOR EVALUATION FORM CONSTRUCTION SAFETY v2.docx
DOCX document 27 KB Posted
- Attached to
- Project No. 667-18-110, Replace Transformer and Correct Electrical Deficiencies, Bldg 4 Federal contract opportunity
- Solicitation number
- 36C25622R0028
About this file
This document contains a federal contract opportunity for replacement of a transformer and electrical deficiencies at a Department of Veterans Affairs medical center. The solicitation will be issued as a 100% set-aside for Service-Disabled Veteran-Owned Small Businesses through request for proposal procedures. Interested offerors must be registered and verified in the Vendor Information Pages database and System for Award Management. The opportunity involves providing all labor, materials and equipment to replace a transformer and correct electrical deficiencies at the Overton Brooks VA Medical Center in Shreveport, Louisiana. The performance period is 180 calendar days with proposals due around February 18th, 2022 and contract award anticipated around 30 days later. The construction cost range is between $500,000 to $1 million under NAICS code 236220.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25622R0028 0001.docx | DOCX document | |
| 36C25622R0028 0002.docx | DOCX document | |
| FCA Basic Report - B4 Electrical.pdf | ||
| RFIs - Bldg 4 Transformer - Shreveport VA.docx | DOCX document | |
| Bldg 4 Transformer Laydown Area.pdf | ||
| 36C25622R0028.docx | DOCX document | |
| EXHIBIT E SURETY FORM.docx | DOCX document | |
| SOW - Replace XFMR and Correct Elec Def B-4.pdf | ||
| EXHIBIT A PERFORMANCE RELEVANCY SURVEY (1).docx | DOCX document | |
| EXHIBIT C SUBCONTRACTOR INFORMATION AND CONSENT.docx | DOCX document | |
| DRWGS - Replace XFMR and Correct Elec Def B-4.pdf | ||
| Building 4 Transformer Class II Precautions Final.docx | DOCX document | |
| Building 4 Transformer ICRA Final.docx | DOCX document | |
| SPECS - Replace XFMR and Correct Elec Def B-4.pdf | ||
| Exhibit B Past and Present Performance Questionnaire.docx | DOCX document | |
| 36C25622R0028- Presolicitation Notice.docx | DOCX document |
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Text version
FOR OFFICIAL USE ONLY
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 |
| 2017 |
| 2018 |
| 2019 |
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 .