36C25625R0079 EXHIBIT D.docx
DOCX document 28 KB Posted
- Solicitation number
- 36C25625R0079
About this file
This document is a Contractor Evaluation Form for a VA medical center project to abate floor mastic in Buildings 1 and 33 at the Overton Brooks VA Medical Center in Shreveport, Louisiana. The pre-solicitation notice is specifically targeted at Service-Disabled Veteran-Owned Small Businesses (SVOSBs) for a construction project with a cost range between $250,000 and $500,000, classified under NAICS code 238330 for Flooring Contractors. The solicitation (36C25625R0079) requires contractors to provide comprehensive labor, materials, tools, equipment, and expertise to complete the floor mastic abatement work.
Key requirements include mandatory SDVOSB certification in the SBA database, SAM registration, and submission of specific documentation such as OSHA 300 forms, safety program details, and insurance Experience Modification Rate (EMR). The official solicitation will be issued on or around 04/11/2025 through SAM.gov, with the contract anticipated to be awarded using FAR 15.101-1 Tradeoff Process. A bid bond will be required, and only one site visit will be conducted, with no make-up visits permitted. Interested offerors must carefully review all RFP documents and comply with strict certification requirements to be considered eligible for evaluation and potential award.
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FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 667-25-188 Abate Floor Mastic, Bldg 1 & Bldg 33 36C25625R0079 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 .