EXHIBIT D.docx
DOCX document 28 KB Posted
- Solicitation number
- 36C25625R0002
About this file
This document is an Exhibit D Contractor Evaluation Form for a VA Medical Center construction project. The solicitation (36C25625R0002) is a 100% set-aside for Service-Disabled Veteran-Owned Small Businesses (SDVOSB) to construct an accessibility ramp at Building 55 of the Overton Brooks VA Medical Center in Shreveport, Louisiana. The project has a construction cost range between $250,000 and $500,000, with a contract performance period of 180 calendar days after the Notice to Proceed.
The procurement will be conducted in two phases, with the Phase I RFP tentatively scheduled for release on 11-08-2024 and proposals due around 11-25-2024. The form requires potential contractors to provide detailed safety information, including OSHA 300 forms, man-hours, workplace injury rates, and insurance Experience Modification Rate (EMR). Offerors must be registered in the System for Award Management (SAM), certified as an SDVOSB in the SBA database, and submit a VA Notice of Limitations on Subcontracting - Certificate of Compliance at the time of proposal submission. The NAICS Code 236220 applies, with a small business size standard of $45M.
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Other files
| File | Type | Posted |
|---|---|---|
| S02 Cancel RFP 36C25625R0002 0002_2.docx | DOCX document | |
| P07 WD LA20250001 05-02-2025.pdf | ||
| S02 RFP Phase II 36C25625R0002 0002 06-06-2025.pdf | ||
| S06 RFIs 04-10-2025.pdf | ||
| S06 667-24-255 Topography-Grading_RFI Answer.pdf | ||
| S06 36C25625R0002 0001.pdf | ||
| S02 Wage Determination 667-24-255 -01-03-2025.pdf | ||
| EXHIBIT C.docx | DOCX document | |
| S02 2016-03-21 Utilities Drawing.pdf | ||
| S02 SOW 10-03-2024.pdf | ||
| EXHIBIT E.docx | DOCX document | |
| EXHIBIT B.docx | DOCX document | |
| EXHIBIT F.docx | DOCX document | |
| EXHIBIT A.docx | DOCX document | |
| S02 RFP 36C25625R0002_1 03-25-2025.pdf | ||
| S02 B55 Ramp-Existing Drawing.pdf | ||
| P09 2016-03-21 Utilities Drawing.pdf | ||
| P09 Statement of Work_Bldg 55 Ramp 08-14-2024.docx | DOCX document | |
| P09 B55 Ramp-Existing Drawing.pdf |
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 667-24-255 Bldg. 55 Accessibility Ramp 36C25625R0002
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 |
| 2022 |
| 2023 |
| 2024 |
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 .