ATTACHMENT 6 - Corrected Contractor Safety - Evaluation Form.docx
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- Solicitation number
- 36E77620B0005
About this file
This solicitation describes a planned construction project at the Robert J. Dole VA Medical Center in Wichita, Kansas. The Department of Veterans Affairs intends to solicit proposals and award a firm-fixed-price contract to renovate and relocate the oncology, hematology, and dialysis areas on the first floor. Work includes general construction, alterations, roads, walks, grading, drainage, necessary removal of existing structures and construction. The solicitation will be issued as an invitation for bid and evaluated according to procedures in the solicitation. The project is expected to be between $2-5 million and will be set aside for Service-Disabled Veteran-Owned Small Businesses. Proposals are due in mid-to-late June 2020 and the period of performance is approximately 270 calendar days from notice to proceed.
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36E77620B0005 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2016 |
| 2017 |
| 2018 |
| 2019 |
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 .