36C26120R0006-0002003.docx
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- Solicitation number
- 36C26120R0006
About this file
This document contains a pre-award contractor safety and environmental record evaluation form and details of a related federal contract opportunity for renovation work. The evaluation form requests contractors to provide safety records from 2017 to 2019 including total man hours, OSHA-reportable incidents, and days away from work rates. It also requests the company's NAICS code, safety program administrator, and insurance experience modification rate along with copies of OSHA forms. The related federal contract opportunity is a competitive set-aside for verified Service-Disabled Veteran-Owned Small Businesses to correct life safety deficiencies in a building lobby at a VA medical center. The estimated solicitation posting date is December 13, 2019 and closing date is January 13, 2020. The NAICS code is 236220 for commercial and institutional building construction up to $39.5 million. The estimated value of the construction project is between $250,000 to $500,000.
36C26120R0006 0002 Pre-Award Contractor Safety and Environmental Record Evaluation Form.docx
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26120R0006-0003002.pdf | ||
| 36C26120R0006-0003001.pdf | ||
| 36C26120R0006-0003000.docx | DOCX document | |
| 36C26120R0006-0003003.pdf | ||
| 36C26120R0006-0002000.docx | DOCX document | |
| 36C26120R0006-0002002.pdf | ||
| 36C26120R0006-0002001.pdf | ||
| 36C26120R0006-0002005.pdf | ||
| 36C26120R0006-0002004.pdf | ||
| 36C26120R0006-0001000.docx | DOCX document | |
| 36C26120R0006-0001001.pdf | ||
| 36C26120R0006-006.pdf | ||
| 36C26120R0006-002.pdf | ||
| 36C26120R0006-004.pdf | ||
| 36C26120R0006-003.pdf | ||
| 36C26120R0006-005.pdf | ||
| 36C26120R0006-001.docx | DOCX document |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2017 |
| 2018 |
| 2019 |
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 explanation 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. | Provide your six-digit North American Industrial Classification System (NAICS) Code for this acquisition: __________________________________ |
| 3. | Who administers your company’s Safety and Health Program? __________________________________ |
| 4. | Company’s Insurance Experience Modification Rate (EMR): _____________ |
File details come from the government source that posted it. Updated .