Attachment E_EXHIBIT A CONTRACTOR EVALUATION FORM CONSTRUCTION SAFETY.pdf
PDF 76 KB Posted
- Attached to
- Y1AA--598-23-106 B65 Structural Repairs-NLR Federal contract opportunity
- Solicitation number
- 36C25625R0087
About this file
The document is a Contractor Evaluation Form for Construction Safety, designed to assess a contractor's safety performance and compliance. The form requires detailed information across three key areas: OSHA recordkeeping, safety program administration, and insurance experience. Specifically, contractors must provide three years of data (2021-2023) including total man-hours, workplace injury/restriction cases, Days Away, Restricted, or Transferred (DART) rate, and any OSHA violations. Contractors are required to attach OSHA 300 and 300a forms, identify who administers their Safety and Health Program, and disclose their current Insurance Experience Modification Rate (EMR). If a company's EMR exceeds 1.0, they must provide a written explanation from their insurance carrier detailing the reasons and an anticipated date for reduction.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25625R0087 0004.pdf | ||
| 36C25625R0087 0003.pdf | ||
| Attch A_RFIs for Building 65 Structural Repairs 36C25625R0087 - VA Response.pdf | ||
| Attch C_Site Visit Sign In Form - 598-23-106 Building 65 Repairs dtd 5-13-2025.pdf | ||
| Attch B_Solicitation Work List Unit Pricing Table.pdf | ||
| 36C25625R0087 0002.docx | DOCX document | |
| 36C25625R0087 0001 Amendment.pdf | ||
| Bldg 65 Structural Repairs Drawings CD 20250131.pdf | ||
| Attachment D -Wage Determination.pdf | ||
| 36C25625R0087 Solicitation_ Completed.pdf | ||
| 36C25625R0087 Site Visit Agenda.docx | DOCX document | |
| Attachment F_EXHIBIT B PERFORMANCE RELEVANCY SURVEY.docx | DOCX document | |
| Bldg 65 Structural Repairs Specifications BD 20250131.pdf | ||
| 598-23-106 B65 SOW v20250121.doc | DOC document | |
| 36C25625R0087_1.docx | DOCX document |
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Text version
FOR OFFICIAL USE ONLY
Exhibit A Contractor Evaluation Form
Construction Safety
Company Name:
Address:
Telephone: Fax:
Email:
Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2021 2022 2023 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 .