5.08 - Attachment 08 - Experience Modification Rate EMR [1 page].docx
DOCX document 14 KB Posted
- Attached to
- Z2DA--Replace Windows and Weather Protection
- Solicitation number
- 36C24824R0135
About this file
This document is an EMR (Experience Modification Rate) form for bidders/offerors to complete and submit with their price proposal. It requests the bidder to provide information on their OSHA 300 forms, NAICS code, safety and health program administrator, and the company's EMR for the past 3 years. An EMR greater than 1.0 disqualifies the contractor. The form also notes that copies of the OSHA 300 and 300a forms must be attached. This EMR form is related to a federal contract opportunity to Replace Windows and Weather Protection at the Lake City VAMC in Florida, solicited by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8.
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Other files
| File | Type | Posted |
|---|---|---|
| 5.03 - Attachment 03 - Wage Determination [5 Pages].pdf | ||
| 5.06 - Attachment 06 - Past Performance Survey [3 pages].docx | DOCX document | |
| 5.01 - Attachment 01 - Drawing [55 Pages].pdf | ||
| 36C24824R0135.docx | DOCX document | |
| 5.05 - Attachment 05 - Past Performance Questionnaire [3 pages].docx | DOCX document | |
| 5.07 - Attachment 07 - Subcontractor Past Performance Consent Form [1 page].docx | DOCX document | |
| 5.02 - Attachment 02 - Specifications [464 Pages].pdf | ||
| 5.04 - Attachment 04 - Price Matrix [1 page].xlsx | XLSX spreadsheet |
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Text version
EMR FORM FOR BIDDER/OFFEROR TO COMPLETE & SUBMIT WITH PRICE PROPOSAL
Pre-Award Contractor Evaluation Form Company Name: ______________________________________________
Address: _____________________________________________________
Telephone: ______________________ Fax: ________________________
Email: _______________________________________________________
Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2021 |
| 2022 |
| 2023 |
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. (Four serious, one repeat, or one willful disqualifies the contractor.)
Please attach copies of the following documents: OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page: http://www.osha.gov/pls/publications/publication.html.
2. Provide your six-digit North American Industrial Classification System (NAICS) Code for this acquisition: __________________________________
3. Who administers your company’s Safety and Health Program? __________________________________
4. Company’s Insurance Experience Modification Rate (EMR) for the past 3 years (an EMR of greater than 1.0 disqualifies the contractor): _____________
File details come from the government source that posted it. Updated .