ATTACHMENT_3--Contractor_Safety_and_EMR_(2_pages).docx
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- Attached to
- Greenstone--ND/SD CONSTRUCTION MATOC
- Solicitation number
- 36C26318R0063
About this file
This document package includes an attachment outlining safety and environmental requirements for a federal construction contract and the related solicitation notice. The attachment provides guidance for submitting safety and environmental compliance documentation, including OSHA violation histories and insurance experience modification rates. Bidders must certify no more than three serious or one repeat/willful OSHA or EPA violations in three years, explaining any that cannot be certified. The solicitation seeks multiple award task order contracts for construction services from $2,000 to $10 million totaling $70 million for the Department of Veterans Affairs in North and South Dakota. The NAICS code is 236220 and it is a 100% set-aside for service-disabled veteran-owned small businesses. Interested parties must register in SAM and ORCA and submit through beta.SAM.gov to be eligible for task orders ranging from $100,000 to $250,000 for an initial seed project.
36C26318R0063 ATTACHMENT 3--Contractor Safety and EMR (2 pages).docx
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Indefinite Delivery Indefinite Quantity (IDIQ) Contracts Solicitation 36C26318R0063
Solicitation Attachment 3 Safety or Environmental Violations and Experience Modification Rate
All Bidders/Offerors shall submit information pertaining to their past Safety and Environmental record. The information must contain a certification that the bidder/offeror 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. If such certification cannot be made, a Bidder/Offeror shall explain why and submit as much information as possible regarding the circumstances of its past safety and environmental record, including the number of EPA violations and/or the number of serious, repeat, and/or willful OSHA violations, along with a detailed description of those violations.
All Bidders/Offerors shall submit information regarding their current Experience Modification Rate (EMR). This information shall be obtained from the Bidder’s/Offeror’s insurance carrier and be furnished on the insurance carrier’s letterhead. If a Bidder/Offeror’s EMR is above 1.0, Bidder/Offeror must submit a written explanation of the EMR from its insurance carrier furnished on the insurance carrier’s letterhead, describing the reasons for the EMR, and the anticipated date the EMR may be reduced to 1.0 or below.
Self insured contractors or other contractors that cannot provide their EMR rating on insurance letterhead must obtain a rating from the National Council on Compensation Insurance, Inc. (NCCI) by completing/submitting form ERM-6 and providing the rating on letterhead from NCCI. Note: Self insured contractors or other contractors that cannot provide EMR rating on insurance letterhead from the states or territories of CA, DE, MI, NJ, ND, OH, PA, WA, WY, and PR shall obtain their EMR rating from their state run worker’s compensation insurance rating bureau.
If the NCCI cannot issue an EMR because the Bidder/Offeror lacks insurance history, Bidder/Offeror shall submit a letter indicating so from its insurance carrier furnished on the insurance carrier’s letterhead, and include a letter from the NCCI indicating that is has assigned Bidder/Offeror a Unity Rating of 1.0.
The above information, along with other information obtained from Government systems, such as the OSHA and EPA online inspection history databases, will be used to make an initial Determination of Responsibility.
This requirement is applicable to all subcontracting tiers, and prospective prime contractors are responsible for determining the responsibility of their prospective subcontractors.
Solicitation Attachment 3 Safety or Environmental Violations and Experience Modification Rate
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 |
| 2015 |
| 2016 |
| 2017 |
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): _____________ |
Page 2 of 2 Attachment 3
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