36C25623R0006 - Exhibit B.docx
DOCX document 28 KB Posted
- Attached to
- 36C25623R0006 - Z1DA--Project #667-23-100 Replace Emergency Department Roof (DB) 36C25623R0006
- Solicitation number
- 667-23-100
About this file
This document contains a contractor evaluation form and details of a related federal contract opportunity. The contractor evaluation form requests safety-related information from offerors, including man-hours and OSHA incident rates for the past three years, as well as documentation of any serious violations. It also asks who administers the company's safety program and its current insurance experience modification rate. The related federal contract opportunity is a solicitation from the Department of Veterans Affairs for design-build services to replace the emergency department roof at Project 667-23-100, with a solicitation number of 667-23-100 and contract number 36C25623R0006. Offerors are required to submit safety documentation and details as part of the proposal response.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25623R0006 0001.pdf | ||
| 1675887701205.jpeg | JPEG file | |
| 1675887593466.jpeg | JPEG file | |
| 1675887952406.jpeg | JPEG file | |
| 1675887555487.jpeg | JPEG file | |
| ED ROOF - Aerial View.pdf | ||
| ED ROOF - Sketch.pdf | ||
| RFI Responses.docx | DOCX document | |
| ED ROOF - Aerial Northwest Quarter.pdf | ||
| ED ROOF - Site Grounds Map.pdf | ||
| 1675887647620.jpeg | JPEG file | |
| 1675887841057.jpeg | JPEG file | |
| 1675887758930.jpeg | JPEG file | |
| P09 Revised SOW Replace ED Roof- 667-23-100 09-12-2022.docx | DOCX document | |
| 36C25623R0006 SOLICITATION .pdf | ||
| 36C25623R0006 - Exhibit A .docx | DOCX document | |
| P09 Class II Precautions - Replace ED Roof 667-23-100 Preliminary.docx | DOCX document | |
| 36C25623R0006 VHA Supplemental Contract Rqts for Combatting COVID-19 (2).docx | DOCX document | |
| P09 ICRA - Replace Emergency Department Roof Preliminary.docx | DOCX document |
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 667-23-100 Replace Emergency Department (ED) Roof 36C25623R0006
Exhibit B Contractor Evaluation Form Construction Safety
Company Name:
Address:
Telephone: Fax:
Email:
Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2020 |
| 2021 |
| 2022 |
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 .