36C25624R0065 EXHIBIT D.docx
DOCX document 31 KB Posted
- Attached to
- Z2DZ--Project #667-24-114 (D/B) Install Decon Shower Drainage System Federal contract opportunity
- Solicitation number
- 36C25624R0065
About this file
This document is a Contractor Evaluation Form related to a federal contract opportunity for the installation of a decon shower drainage system at the Overton Brooks VA Medical Center in Shreveport, Louisiana.
The key details are:
- The procurement will be issued as a 100% Service-Disabled Veteran-Owned Small Business (SDVOSB) set-aside through the Request for Proposal (RFP) process under FAR 15.
- The Phase I RFP is tentatively scheduled to be issued around 6/13/2024 with proposals due approximately 30 days later. The Phase II RFP will be sent to selected firms after Phase I evaluations.
- The anticipated contract award is approximately 30 days or less after receipt of Phase II proposals. The contract performance period is 130 calendar days after the Notice to Proceed.
- The construction cost range for this project is between $100,000 and $250,000.
- The Contractor Evaluation Form requests information on the offeror's safety record, including OSHA 300 forms, number of OSHA violations, and current insurance Experience Modification Rate.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25624R0065 SOW.docx | DOCX document | |
| 36C25624R0065 RFP.docx | DOCX document | |
| 36C25624R0065 EXHIBIT C.docx | DOCX document | |
| 36C25624R0065 EXHIBIT B.docx | DOCX document | |
| 36C25624R0065 WD LA20240031 MOD 0 01052024.pdf | ||
| 36C25624R0065 EXHIBIT F.docx | DOCX document | |
| 36C25624R0065 EXHIBIT E.docx | DOCX document | |
| 36C25624R0065 EXHIBIT A.docx | DOCX document | |
| SOW - DB Install Decon Shower Drainage System.docx | DOCX document | |
| 36C25624R0065 Pre-Sol.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. 667-24-114; Install Decon Shower Drainage System 36C25624R0065
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 |
| 2021 |
| 2022 |
| 2023 |
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 .