36C25622R0062 EXHIBIT D.docx
DOCX document 28 KB Posted
- Solicitation number
- 36C25622R0062
About this file
This document contains a contractor evaluation form for a construction project. The form requests safety information from offerors including man hours, OSHA injury rates, violations, and insurance experience modification rates. Offerors must provide OSHA 300 forms from 2019 to 2021 and an insurance carrier letter if their modification rate exceeds 1.0. The related federal contract opportunity is for project 667-19-101 to tuckpoint Building 1 at a Veterans Affairs main hospital. The solicitation was issued by the Veterans Health Administration Veterans Integrated Service Network 16 to solicit proposals for this construction project.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 36C25622R0062 SOW .docx | DOCX document | |
| 36C25622R0062 Part 7 DRWGS .pdf | ||
| 36C25622R0062 Part 6 DRWGS .pdf | ||
| 36C25622R0062 WD LA20220031 Mod 2 02252022.docx | DOCX document | |
| 36C25622R0062 ICRA .pdf | ||
| 36C25622R0062 EXHIBIT B.docx | DOCX document | |
| 36C25622R0062 Specifications.pdf | ||
| 36C25622R0062 EXHIBIT E.docx | DOCX document | |
| 36C25622R0062 COVID-19 Safety Protocols for Federal Contractors rev2 .docx | DOCX document | |
| 36C25622R0062 Part 8 DRWGS .pdf | ||
| 36C25622R0062 CRA .pdf | ||
| 36C25622R0062 Part 5 DRWGS .pdf | ||
| 36C25622R0062 EXHIBIT C.docx | DOCX document | |
| 36C25622R0062 Part 2 DRWGS .pdf | ||
| 36C25622R0062 Part 1 DRWGS .pdf | ||
| 36C25622R0062 RFP.docx | DOCX document | |
| 36C25622R0062 Part 4 DRWGS .pdf | ||
| 36C25622R0062 EXHIBIT A.docx | DOCX document | |
| 36C25622R0062 Part 3 DRWGS .pdf | ||
| 36C25622R0062 ILSM .pdf | ||
| 36C25622R0062 EXHIBIT F.docx | DOCX document |
Show all 21
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. 667-19-101 Tuckpoint BLDG 1, Main Hospital 36C25622R0062 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 |
| 2019 |
| 2020 |
| 2021 |
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 .