36C25624R0115 EXHIBIT D.docx
DOCX document 28 KB Posted
- Solicitation number
- 36C25624R0115
About this file
This document is a Contractor Evaluation Form for a federal contract opportunity solicitation number 36C25624R0115, for the project of installing fire doors for Buildings 7 and 9. The solicitation is issued by the Department of Veterans Affairs, Veterans Health Administration, Veterans Integrated Service Network 16. The form requires the contractor to provide information on their OSHA 300 forms, including the number of manhours, cases involving days away from work, days away/restricted/transferred rate, and any OSHA violations in the last 3 years. The contractor must also provide information on who administers their safety and health program and their current insurance experience modification rate (EMR). If the EMR is greater than 1.0, the contractor must provide a written explanation from the insurance carrier. This information will be used to evaluate the contractor's safety performance as part of the contract award decision.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 502-24-904 RFI Register 08272024.docx | DOCX document | |
| 36C25624R0115 0003.docx | DOCX document | |
| 36C25624R0115 0002.docx | DOCX document | |
| 36C25624R0115 0001.docx | DOCX document | |
| 502-24-904 Site Visit Sign in Sheet.pdf | ||
| 36C25624R0115 PRA 502-24-904 .pdf | ||
| 36C25624R0115 WD LA20240051 Mod 1 dtd 5.17.24 .txt | TXT text file | |
| 36C25624R0115 SOW 08082024 .docx | DOCX document | |
| 36C25624R0115 LS Drawing Bldg 7 .pdf | ||
| 36C25624R0115 081113 .docx | DOCX document | |
| 36C25624R0115 087100 .docx | DOCX document | |
| 36C25624R0115 EXHIBIT B.docx | DOCX document | |
| 36C25624R0115 EXHIBIT C.docx | DOCX document | |
| 36C25624R0115 RFP.docx | DOCX document | |
| 36C25624R0115 EXHIBIT E.docx | DOCX document | |
| 36C25624R0115 EXHIBIT A.docx | DOCX document | |
| 36C25624R0115 081400 .docx | DOCX document | |
| 36C25624R0115 EXHIBIT F.docx | DOCX document | |
| 36C25624R0115 LS Drawing Bldg 9 .pdf | ||
| 36C25624R0115 010000 .docx | DOCX document |
Show all 20
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. 502-24-904 Fire Doors for BLDG 7 & 9 36C25624R0115
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 .