36C25623R0039 EXHIBIT D.docx
DOCX document 28 KB Posted
- Attached to
- 520-18-119 Install Photovoltaic Array, JACC Federal contract opportunity
- Solicitation number
- 36C25623R0039
About this file
This document contains a contractor evaluation form for a federal construction project. The form requests safety and insurance information from offerors bidding on Project No. 520-18-119 to install a photovoltaic array at the Joint Ambulatory Care Clinic in Pensacola, Florida. It solicits a company's OSHA 300 forms from 2019 to 2021 detailing man hours, days away from work cases, and DART rates. It also requests information on serious OSHA violations in the past three years and copies of the company's OSHA 300 and 300a forms. The form asks who administers the company's safety and health program and the current insurance experience modification rate, requiring it be obtained from the offeror's insurance carrier on letterhead. It states any EMR over 1.0 requires a written explanation from the carrier describing reasons for the rate and anticipated date for reduction.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| VOL 2 BINDER.pdf | ||
| 36C25623R0039 RFIs main.docx | DOCX document | |
| 36C25623R0039 0002.pdf | ||
| VOL 3 BINDER.pdf | ||
| VOL 1 BINDER.pdf | ||
| 36C25623R0039 0001.docx | DOCX document | |
| JACC solar ICRA Pre_Construction.pdf | ||
| Drawings.pdf | ||
| DB-ATTACH ATTACHMENT I - RELEASE OF CLAIMS.docx | DOCX document | |
| 36C25623R0039 Solicitation 12-29-2022.pdf | ||
| 36C25623R0039 EXHIBIT F.docx | DOCX document | |
| WD FL20220203 Mod 3 Dtd 9-01-2022.txt | TXT text file | |
| VHA Supplemental Contract Requirements for Combatting COVID-19.docx | DOCX document | |
| SOW_JACC SOLAR PV rev 10-5-22.docx | DOCX document | |
| Specs.pdf | ||
| 36C25623R0039 EXHIBIT E.docx | DOCX document | |
| 36C25623R0039 EXHIBIT B.docx | DOCX document | |
| 36C25623R0039 EXHIBIT A.docx | DOCX document | |
| 36C25623R0039 EXHIBIT C.docx | DOCX document |
Show all 19
On GovTribe
Work with this file on GovTribe
- 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. 520-18-119 Install Photovoltaic Array 36C25623R0039
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 .