4-Attachment B- Safety Documents.pdf
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- Solicitation number
- Competitive Sealed Proposal (CSP) for Renovations at Bryker Woods Elementary School (Estimated Budget $3,269,810.00)
- Issued by
- Travis County, Austin City, Texas
About this file
This is Attachment B, a safety record documentation requirement from the Austin Independent School District's Contract and Procurement Services for prospective bidders. The attachment outlines four specific safety documentation requirements that organizations must provide as part of their bid submission: OSHA 300 Logs and 300A Summary Forms for the last three completed calendar years, loss runs from insurance carriers covering workers' compensation (also referred to as "statement of claims"), loss ratios from insurance carriers for the most recent completed policy year, and current experience modifiers from workers' compensation insurance providers. All documents must be completed, signed, dated, and clearly show the insurance carrier or agency information, with specific timing requirements that loss runs, loss ratios, and experience modifiers must be printed within 60 calendar days of the bid due date.
The documentation requirements emphasize that all safety records must be provided directly by insurance carriers, agents, or rating agencies, with typed or handwritten information prepared by the bidding firm being explicitly rejected. If there are no recordable injuries on OSHA 300 logs for a specific year, those logs are not required, but the 300A Summary Forms must still be submitted for every year with zeros recorded in appropriate columns if no accidents occurred. Similarly, if loss runs indicate no losses, separate documents showing 0% loss ratios are not required, and claimant names may be redacted from loss run documentation for privacy purposes. The attachment includes a quick reference summary table that consolidates all requirements, emphasizing the critical nature of proper documentation from authorized insurance sources and adherence to the 60-day printing deadline for current policy documents.
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Attachment B
1. Safety Record Please provide the following information in connection with your organization’s safety record.
1.1. Your organization's OSHA (Occupational Safety and Health Administration) 300 Logs and 300A Form Logs for the last three completed Calendar (3) years.
-- If there are no recordable injuries on the OSHA 300 log(s) FOR A SPECIFIC YEAR, the 300 log(s) FOR THAT SPECIFIC YEAR will not be required to be submitted. However, the OSHA 300A Summary Form Log must still be submitted FOR EVERY YEAR.
-- OSHA 300 A Summary Form log must be completed signed and dated. If no accidents, record "0" in appropriate column totals.
1.2. Loss run from your organization's insurance carrier or insurance agency covering your organization's workers' compensation insurance coverage. (Loss run is also referred to as "statement of claims" or SOC.) A loss analysis/loss summary may be submitted as long as it contains individual claims descriptions.
-- Loss run must be provided by your organization’s insurance carrier or insurance agency.
Insurance carrier’s company name or insurance agent (Agency) must be clearly legible on documents provided.
-- Names of claimants on loss run may be redacted/blacked out.
-- If there have been no losses, provide Document from your firm’s insurance carrier stating no losses.
-- Loss Run/Loss Analysis/Loss Summary must be from the most recently completed policy year.
-- This Document must be printed 60 calendar days or less before the bid due date. Date printed must be clearly indicated on the Document.
1.3. Loss ratio from your organization’s insurance carrier or insurance agency covering your organization’s workers’ compensation insurance coverage.
-- Loss ratio must be provided by your organization’s insurance carrier or insurance agency.
Insurance carrier’s company name or insurance agent) Agency_ must be clearly legible on documents provided.
-- Time period corresponding to loss ratio must be provided for the most recent completed policy year.
-- Typed or handwritten information concerning loss ratio prepared by your firm WILL NOT be accepted.
-- Experience rating documents WILL NOT be accepted for this section.
-- If your Loss Run/Loss Analysis/Loss Summary for the most completed policy period indicates no losses, then a separate document showing 0% loss ratio will not be required.
-- This Document must be printed 60 calendar days or less before the bid due date. Date printed must be clearly indicated on the Document.
1.4. Your organization’s current experience modifier from your organization’s workers’ compensation insurance premiums provided by your organization’s insurance carrier, insurance agency or rating agency.
-- Experience modifier must be provided by your organization’s insurance carrier, insurance agent or rating agency. Insurance carrier’s company name or insurance agent (agency) must be clearly legible on documents provided.
-- Experience modifier must clearly indicate time period/year covered for the current experience modifier.
--Typed or hand-written experience modifiers prepared by your firm WILL NOT be accepted.
-- Experience rating documents indicating a calculated experience modifier will be accepted provided there is a final calculated experience modifier with applicable year indicated.
-- This Document must be printed 60 calendar days or less before the bid due date. Date printed must be clearly indicated on the Document.
SAFETY RECORD QUICK SUMMARY:
OSHA 300 Logs and 300A Form Logs
• The last three (3) completed Calendar years
• OSHA 300A Summary Form Log must be completed signed and dated. If not accidents, record “0” in appropriate column totals.
Loss Run
• Also referred to as “statement of claims” or SOC
• Insurance agency must be clearly labeled
• Must be from the most recent completed policy year
• Must be printed 60 calendar days or less before bid due date.
• Date printed must be clearly indicated on the Document
Loss Ratio
• Insurance agency must be clearly labeled
• Must correspond to most recent completed policy year
• If your Loss Run indicated no losses a separate document showing
0% loss ratio will not be required.
• Must be printed 60 calendar days or less before bid due date.
• Date printed must be clearly indicated on the Document
Experience Modifier
• Insurance agency must be clearly labeled
• Must be printed 60 calendar days or less before bid due date.
• Date printed must be clearly indicated on the Document
• Your organization’s current workers’ compensation insurance premiums provided by your organization’s insurance carrier, insurance agency, or rating agency
File details come from the government source that posted it. Updated .