Corrected Responsibility - Contractor Certification Regarding Safety and Environmental.pdf
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- Attached to
- Z2DA--Interventional Imaging Surgical Suite-- Design-Build--Unrestricted Federal contract opportunity
- Solicitation number
- 36C26121R0096
About this file
This document outlines safety and environmental certification requirements for a design-build construction contract. The contract is to upgrade an operating room into an interventional imaging surgical suite at the Veterans Affairs Central California Health Care System in Fresno, California. Bidders must certify in writing that they have no more than three serious, one repeat, or one willful OSHA or EPA violations in the past three years. They must also disclose their current experience modification rate from their insurance carrier, which must be less than or equal to 1.0. The construction value is between $2,000,000 and $5,000,000. The solicitation will use a two-phase design-build selection process and bonds will be required.
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Text version
CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL
Contractor Certification Regarding Project: 570-CSI-416
Title: Design-Build Interventional Imaging Surgical Suite in Building 1
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 Offerors 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.
2018 2019 2020
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 offerors 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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