36C25625R0064 EXHIBIT D.docx
DOCX document 28 KB Posted
- Attached to
- Z1DA--Project 667-25-185 CON Install VAV Boxes Surgery Storage Federal contract opportunity
- Solicitation number
- 36C25625R0064
About this file
This document is a Contractor Evaluation Form for a Department of Veterans Affairs construction project (Project 667-25-185) involving installation of VAV boxes in a surgery storage area. The form requires contractors to provide detailed safety performance information, including OSHA documentation for 2022-2024, such as man hours, workplace injury cases, DART (Days Away, Restricted, or Transferred) rates, and any OSHA violations. Contractors must also submit their current Insurance Experience Modification Rate (EMR) on insurance carrier letterhead, with additional explanation required if the EMR exceeds 1.0. The solicitation (36C25625R0064) is associated with the Veterans Health Administration's Veterans Integrated Service Network 16 and is scheduled to close on 4/29/2025 at 2:00 PM.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| VAV Project_Updated Drawings 4.7.25.pdf | ||
| 36C25625R0064 0001.pdf | ||
| Project No. 667-25-185 Site Visit Sign In 4.7.25.pdf | ||
| Install VAV Boxes Surgery Storage ICRA.pdf | ||
| P07 WD LA20250031 Mod 0 dtd 1.3.2025.txt | TXT text file | |
| 36C25625R0064 EXHIBIT C.docx | DOCX document | |
| 36C25625R0064 EXHIBIT E.docx | DOCX document | |
| P09 Surgery VAV - 1 - SOW.doc | DOC document | |
| 667-25-185 Combined Specs.pdf | ||
| 36C25625R0064 EXHIBIT A.docx | DOCX document | |
| 36C25625R0064 EXHIBIT B.docx | DOCX document | |
| 36C25625R0064 EXHIBIT F.docx | DOCX document | |
| SURGERY VAV - 2 - DRAWINGS.pdf | ||
| Install VAV Boxes Class V Precautions.docx | DOCX document | |
| 36C25625R0064 SOL.pdf |
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 667-25-185 Install VAV Boxes Surgery Storage
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 .