36C25625R0084 EXHIBIT D.docx
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- Solicitation number
- 36C25625R0084
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Exhibit D is a Contractor Evaluation Form for a design-build contract (RFP #36C25625R0084) focusing on Temporary Shoring & Safety Measures for Parking Garages at the Southeast Louisiana Veterans Healthcare System in New Orleans. The document requires potential contractors to submit detailed safety performance information, including OSHA 300 Forms covering man-hours, workplace injury rates, and OSHA violations for the years 2022-2024, as well as their current Insurance Experience Modification Rate (EMR).
The solicitation is a 100% set-aside for Service-Disabled Veteran-Owned Small Businesses (SDVOSB) under NAICS Code 236220, with a construction cost range between $100,000 and $250,000. The RFP is tentatively scheduled for release on 04/28/2025, with first-phase proposals due approximately 30 calendar days later. The contract performance period is 150 calendar days after the Notice to Proceed, and offerors must be verified in the SBA VetCert database and registered in SAM. Contractors will need to provide architectural plans and specifications for VA approval before construction, with a two-phase evaluation process determining the final awardee.
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FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 629-25-100; Temporary Shoring & Safety Measures for Parking Garages 36C25625R0084
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 .