CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL.docx

This is a Contractor Certification form regarding safety and environmental compliance for a specific federal construction project. The form applies to Project 612A4-27-018, Replace B650 3rd and 2nd Flooring, conducted by the VA Northern California Health Care System at the Sacramento Veterans Affairs Medical Center (10535 Hospital Way, Mather, CA 95655). The certification requires contractors to disclose the number of serious, willful, or repeat violations from OSHA within the last three years and the number of serious, willful, or repeat EPA violations within the same timeframe; contractors must provide written explanations for any violations identified. Contractors are disqualified if they have four serious violations, one repeat violation, or one willful violation in either OSHA or EPA categories.

The form also requires contractors to provide their current Insurance Experience Modification Rate (EMR), supported by a signed letter from their insurance carrier on official letterhead. Contractors must sign the certification and provide their typed name and title. This certification is a mandatory compliance document for bidders on Solicitation Number 36C26127Q0026 for the flooring replacement project, which involves demolition and replacement of flooring, resilient base, stainless steel corner guards, and paint on the 3rd and 2nd floors of Building 650. Work must be performed outside normal business hours (7:30 AM to 4:00 PM, Monday through Friday), and contractors are responsible for all waste disposal and compliance with VA infection control procedures.