36C26119B0031-007.docx
DOCX document 14 KB Posted
- Attached to
- 640-16-114 Replace Building 100 & 101 Flooring Repair Federal contract opportunity
- Solicitation number
- 36C26119B0031
About this file
This document contains a contractor certification form and a related federal contract opportunity notice. The contractor certification form requires bidders to have no more than three serious, one repeat, or one willful OSHA or EPA violations in the past three years, and an experience modification rate of 1.0 or less. Bidders must submit a self-certification letter and documentation of their experience modification rate from their insurance carrier.
The related federal contract opportunity is to replace flooring in Buildings 100 and 101 at the VA Palo Alto Health Care System for $2,000,000 to $5,000,000. The solicitation will be set aside for Service-Disabled Veteran-Owned Small Businesses and issued on May 24, 2019. Bids are due 30 days after issuance unless extended. The contractor must furnish all labor, materials, equipment, and supervision to repair and replace flooring on four floors over a 480 day period of performance.
36C26119B0031 CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL.docx
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C26119C0122-000.docx | DOCX document | |
| 36C26119B0031-0005000.docx | DOCX document | |
| 36C26119B0031-0004000.docx | DOCX document | |
| 36C26119B0031-0004001.pdf | ||
| 36C26119B0031-0003000.docx | DOCX document | |
| 36C26119B0031-0003001.pdf | ||
| 36C26119B0031-0002000.docx | DOCX document | |
| 36C26119B0031-0001000.docx | DOCX document | |
| 36C26119B0031-006.pdf | ||
| 36C26119B0031-008.docx | DOCX document | |
| 36C26119B0031-005.doc | DOC document | |
| 36C26119B0031-009.docx | DOCX document | |
| 36C26119B0031-001.docx | DOCX document | |
| 36C26119B0031-002.pdf | ||
| 36C26119B0031-010.docx | DOCX document | |
| 36C26119B0031-004.pdf | ||
| 36C26119B0031-003.pdf | ||
| 36C26119B0031-000.docx | DOCX document |
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Text version
CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL
Contractor Certification Regarding Project: 640-16-114
PER VHA DIRECTIVE 7715 (06 April 2017): SAFETY & ENVIRONMENTAL RECORD AND EXPERIENCE MODIFICATION RATE (EMR): To be eligible for consideration and award, the contractor shall have no more than three serious, or one repeat, or one willful OSHA or EPA violation(s) in the past 3 years and have an EMR of equal to or less than 1.0.
All Bidders shall submit the following information pertaining to their past Safety & Environmental Record and EMR with their bid.
1. SAFETY & ENVIRONMENTAL RECORD: A self-certification on company letterhead that the bidder has no more than three (3) serious, or one (1) repeat or one (1) willful OSHA or any EPA violation(s) in the past three years.
EMR: All bidders shall submit information regarding their current EMR. This information shall be obtained from the bidder’s insurance carrier and be furnished on the insurance carrier’s letterhead.
| 2016 |
| 2017 |
| 2018 |
Number of serious, willful, or repeat violations from OSHA within the last 3 years.
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: ______________________________________________________
File details come from the government source that posted it. Updated .