36E77619R0097-015.docx

DOCX document Posted

Attached to
Construct Clean Core (VA-19-00058573) Federal contract opportunity
Solicitation number
36E77619R0097
Issued by
Department of Veterans Affairs Headquarters

About this file

This document contains a contractor safety evaluation form and details of a federal contract opportunity for construction services. The Department of Veterans Affairs is seeking bids to construct a clean core addition to the surgical suite at the Providence, Rhode Island VA Medical Center. Bidders must complete a safety evaluation form providing man-hours and OSHA record information from 2015 to 2018. The approximately 6,800 gross square foot project involves constructing a new surgery suite space and clean core in an elevated second floor addition, renovating existing space, and relocating locker rooms and cystoscopy facilities. Bids will be evaluated under the Lowest Price Technically Acceptable procedure. The solicitation number is 36E77619R0097 and will be issued on October 16, 2019 as a total Service-Disabled Veteran-Owned Small Business set-aside. The period of performance is approximately 490 calendar days and the construction value is estimated between $5 million to $10 million. Questions must be submitted in writing by the specified date.

36E77619R0097 Attachment 12 - Contractor Safety and Environmental Record Evaluation Form.docx

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Contractor Safety and Environmental Record Evaluation Form

Information provide below is current and applicable to Solicitation 36E77619R0097 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:

Category
2015
2016
2017
2018

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.

File details come from the government source that posted it. Updated .