36C25625R0083 EXHIBIT D.docx
DOCX document 28 KB Posted
- Solicitation number
- 36C25625R0083
About this file
This document is a Contractor Evaluation Form for a VA Medical Center construction project (Solicitation 36C25625R0083) to replace Building 55's 1st and 2nd floor boiler. The pre-solicitation notice is specifically targeted at Service-Disabled Veteran-Owned Small Businesses (SVOSBs) for a construction project in Shreveport, LA, with a project cost range between $250,000 and $500,000. The project falls under NAICS code 238220 for Plumbing, Heating, and Air Conditioning Contractors and will require a Bid Bond.
Key requirements include mandatory SDVOSB certification through the SBA database, SAM registration, and compliance with specific VA eligibility criteria. The official solicitation will be issued on or around 04/18/2025 on SAM.gov, with the Contracting Officer using a Tradeoff Process (FAR 15.101-1) for award selection. The evaluation form requires detailed safety documentation, including OSHA 300 forms, man-hours, workplace injury rates, and insurance Experience Modification Rate (EMR), which must be less than or equal to 1.0.
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| File | Type | Posted |
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| 667-25-200 RFI Register 05212025 .docx | DOCX document | |
| 36C25625R0083 0003.docx | DOCX document | |
| 667-25-200 Site Visit Sign in Sheet.pdf | ||
| 36C25625R0083 0002.docx | DOCX document | |
| 36C25625R0083 0001.docx | DOCX document | |
| 36C25625R0083 667-25-200 Specs.pdf | ||
| 36C25625R0083 SOW v2 03272025.doc | DOC document | |
| 36C25625R0083 Replace Bldg 55 Boiler ICRA .pdf | ||
| 36C25625R0083 EXHIBIT A.docx | DOCX document | |
| 36C25625R0083 EXHIBIT F.docx | DOCX document | |
| 36C25625R0083 BLD 55 Boiler - 3 - DWG_Update .pdf | ||
| 36C25625R0083 Pump schedule .pdf | ||
| 36C25625R0083 EXHIBIT C.docx | DOCX document | |
| 36C25625R0083 EXHIBIT E.docx | DOCX document | |
| 36C25625R0083 WD LA20250031 02282025.pdf | ||
| 36C25625R0083 RFP.docx | DOCX document | |
| 36C25625R0083 Class III Precautions - Bldg 55 Boiler Replacement .pdf | ||
| 36C25625R0083.docx | DOCX document | |
| 36C25625R0083 SOW 03272025 .doc | DOC document |
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project #667-25-200 Replace Building 55 1st and 2nd Floor Boiler 36C25625R0083
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 .