Attachment 16 - Contractor Safety _ Env Record Form.docx
DOCX document 14 KB Posted
- Attached to
- Y1GZ--Construct Replacement Warehouse Prescott VAMC (Minor Construction) Federal contract opportunity
- Solicitation number
- 36E77620R0043
About this file
This document provides details for a federal solicitation requesting proposals for the construction of a replacement warehouse facility at the Northern Arizona VA Health Care System in Prescott, Arizona. The solicitation will be issued as a Request for Proposal evaluated using Lowest Price Technically Acceptable procedures. The project scope involves constructing a new approximately 10,930 square foot conditioned warehouse building with associated site work including over 30,000 square feet of paving and 5,000 square feet of hardscaping. The estimated value of construction is between $5 million and $10 million. The solicitation will be set aside as a total SDVOSB set-aside and issued on or around July 27th, 2020 with a performance period of approximately 360 calendar days. Questions must be submitted in writing by the specified date.
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36E77620R0043 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2017 |
| 2018 |
| 2019 |
| 2020 |
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 .