36C26118B0181-011.docx
DOCX document 13 KB Posted
- Attached to
- Project 612A4-17-114 Replace Fire Alarm System Building 700 Federal contract opportunity
- Solicitation number
- 36C26118B0181
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36C26118B0181 CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL.docx
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| 36C26118B0181-A00002000.docx | DOCX document | |
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| 36C26118B0181-012.pdf | ||
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CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL
Contractor Certification Regarding Project: 612A4-17-114
| 2015 |
| 2016 |
| 2017 |
| 2018 |
Number of serious, willful, or repeat violations from OSHA within the last 3 years. Please attach explanation for any violations. (Four serious, one repeat, or one willful disqualifies the contractor.)
Company’s Current Insurance Experience Modification Rate (EMR) = _____________ (Note: Contractor must support the EMR with a signed letter from Insurance Carrier on their letterhead.)
Signature: ______________________________________________
Typed Name: ______________________________________________________
Title: ______________________________________________________
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