ATTACHMENT D - CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL.docx
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- Attached to
- Y1LZ--Construct Additional Parking Lots Federal contract opportunity
- Solicitation number
- 36C26120R0028
About this file
This document outlines requirements for a design-build construction contract opportunity with the Department of Veterans Affairs. The solicitation will construct additional parking lots totaling approximately 500,000 square feet at the VA Southern Nevada Health Care System campus in Las Vegas. Work will include asphalt paving, lighting, signage, and stormwater management for areas A1, A2, B, and C, resulting in over 1,000 additional parking spaces. This is a two-phase design-build project with a value between $2-5 million. The opportunity is set aside for qualified Service-Disabled Veteran Owned Small Businesses. Proposals are due on or around April 27, 2020 though the date may be delayed due to local shelter-in-place orders.
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Text version
CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL
Contractor Certification Regarding Project: 593-19-308 Titled Construct Additional Parking Lots 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/proposal:
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. Include the following table and signature block.
| 2017 |
| 2018 |
| 2019 |
Number of serious, willful, or repeat violations from OSHA within the last 3 years.
Number of serious, willful, or repeat violations from EPA within the last 3 years
Signature: ______________________________________________ Typed Name: ______________________________________________________ Title: ______________________________________________________
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.
Company’s Current Insurance Experience Modification Rate (EMR) = _____________ (Note: Contractor must support the EMR with a signed letter from Insurance Carrier on their letterhead.)
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