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This document provides details for a federal contract opportunity for replacing underground utilities at a Veterans Affairs facility in White River Junction, Vermont. The Department of Veterans Affairs seeks to award a firm-fixed price design-bid-build construction contract through a tiered evaluation process, with priority first given to service-disabled veteran-owned small businesses, then veteran-owned small businesses, then HUBZone small businesses and 8(a) participants, and finally other small businesses if necessary. The project scope involves general construction and infrastructure work to upgrade underground utilities at the 163 Veterans Drive location. The performance period is approximately 545 calendar days from notice to proceed, with the solicitation to be issued on or around December 20, 2019 and a magnitude of construction estimated between $5 million to $10 million. Questions must be submitted in writing by the stated deadline.

36E77620R0012 S02 - Attachment 5 - Contractor Safety and Environmental Record Eval Form.docx

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Other files attached to Tiered Evaluation Pre-Solicitation Notice White River Junction Replace Underground Utilities Construction Project, newest first.
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36E77620R0012-0006000.docx DOCX document
36E77620R0012-0006001.docx DOCX document
36E77620R0012-0005001.pdf PDF
36E77620R0012-0005000.docx DOCX document
36E77620R0012-0004000.docx DOCX document
36E77620R0012-0003001.doc DOC document
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36E77620R0012-0002002.pdf PDF
36E77620R0012-0002003.pdf PDF
36E77620R0012-0002000.docx DOCX document
36E77620R0012-0002001.pdf PDF
36E77620R0012-0002004.xlsx XLSX spreadsheet
36E77620R0012-0001004.pdf PDF
36E77620R0012-0001002.pdf PDF
36E77620R0012-0001001.pdf PDF
36E77620R0012-0001000.docx DOCX document
36E77620R0012-0001003.pdf PDF
36E77620R0012-098.pdf PDF
36E77620R0012-095.docx DOCX document
36E77620R0012-096.doc DOC document
36E77620R0012-097.pdf PDF
36E77620R0012-103.docx DOCX document
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36E77620R0012-104.xlsx XLSX spreadsheet
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Text version

Contractor Safety and Environmental Record Evaluation Form

Information provide below is current and applicable to Solicitation 36E77619R0100 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 .