5 - Exhibit A Quantities Prices and Data.pdf
PDF 326 KB Posted
- Attached to
- 438168-CC-24 RSL Room Upgrades
- Solicitation number
- 438168-CC-24
- Issued by
-
Department of Energy
About this file
This document is an Exhibit A, Quantities Prices and Data, related to a firm-fixed-price construction subcontract under Solicitation No. 438168-CC-24. It includes the consideration schedule, modification pricing multipliers, training and badging requirements, payment terms, and measurement for payment details.
The subcontractor is required to provide labor, materials, and equipment to perform demolition of an existing wall partition and door, construct a new wall and install an access door, and complete related finishing work to modify an existing interior space. The subcontract includes firm-fixed-unit pricing for various line items, with milestone and progress payments allowed. Modification pricing is subject to pre-established multipliers for bonds, G&A, and profit. Subcontractor personnel must complete CONTRACTOR-provided training prior to starting on-site work. The solicitation is using a lowest price technically acceptable evaluation method, with proposals evaluated on experience level and schedule criteria.
View the file
Other files
Show all 16
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Exhibit A Solicitation No. 438168-CC-24 Subcontract No. TBD 01/11/24 Page 1 of 17
MISSION SUPPORT AND TEST SERVICES, LLC
FIRM-FIXED-PRICE CONSTRUCTION SUBCONTRACT
EXHIBIT A
QUANTITIES, PRICES AND DATA
TABLE OF CONTENTS
FORM TITLE PAGE
Form A Consideration Schedule Form B Subcontractor and Vendor List Form C Evaluation Criteria Form D Experience Statement Form E Lower-Tier Subcontractor Experience Statement Form F Project Organization Description Form G Resumes of Key Personnel Form H Safety Program Form I Safety and Health History Form J Lower-Tier Subcontractor Safety and Health History Form K Subcontract Schedule
01/11/24 Page 2 of 17
FORM A CONSIDERATION SCHEDULE
NOTE: Form A, with the blanks filled in based on the awarded proposal(s) or agreement of the Offeror and CONTRACTOR shall become part of the resulting subcontract.
1. SCHEDULE OF QUANTITIES AND PRICES
The unit prices shown are all-inclusive Firm-Fixed-Unit-Prices (including e.g., labor, materials, G&A, overhead, profit or fee, taxes (including sales or use taxes required to be paid by Subcontractor for materials or services incorporated into the construction project)*, any other costs required to be paid by law, regulation, or ordinance, and any other cost of whatsoever nature). Payment of the Prices shall constitute full payment for the performance of the Work and covers all costs of whatever nature incurred by SUBCONTRACTOR in accomplishing the Work in accordance with the provisions of the Subcontract and are not subject to escalation for any cause, except as may otherwise be provided in this Subcontract.
*Other than for materials or services incorporated into the construction project, sales tax is not included in the price but shall be added to each invoice as a separate line item if applicable to the CONTRACTOR under this Subcontract/Order in accordance with applicable state law.
Item Number Description of item Quantity
Unit of
Issue Unit Price Total
Completion Date
Milestone or
Progress Payments
Bond(s) and/or Irrevocable Letter of Credit (ILC) A. Payment Bond or
ILC
B. Performance
Bond (See “Performance & Payment Bonds” in Exhibit D)
Each Each
02 Work Control Package 1 Job $ $
Training in Las Vegas or at NNSS, as required by Exhibit B, Statement of Work, and Exhibit E.
1 Job or Task $ $
Mobilization to the Jobsite of all resources required to accomplish the work
1 Job $ $
Construction: Furnish all necessary materials, labor, and equipment, on and off site fabrication, as required by the statement of work, specifications, drawings, and herein.
Work to include installation or specified accessories/ancillary items, inspection, and
01/11/24 Page 3 of 17 testing where and when required.
Demobilization from the Jobsite of all Subcontractor’s resources and final cleanup.
Total Amount
2. MODIFICATION PRICING MULTIPLIERS/RATES
A. MODIFICATION PRICING MULTIPLIERS
The Pricing Multipliers provided in Subsection B below are "fixed" mark-ups for the purpose of negotiating Firm-Fixed-Price Subcontract modifications. No categories other than those annotated below shall be applied to price changes. The pricing multipliers below shall apply to Subcontract modifications for the duration of the Subcontract. Both additive and deductive modifications shall be subject to these multipliers. Any changes made to this Subcontract will be in accordance with Exhibit C, C-21 “Changes.” Changes include change orders, revisions, modifications, equitable adjustments, and anything else which would require or result in a modification to this Subcontract or a Task Order (if applicable) in accordance with the Changes Clause. The SUBCONTRACTOR shall adhere to the pre-established modification multipliers for Bonds, G&A, and Profit. SUBCONTRACTOR shall enforce through negotiations with its Lower-Tier Subcontractors the rates in the table below for modifications. The CONTRACTOR shall review all SUBCONTRACTOR quotes to ensure compliance with contractual terms.
B. SUBCONTRACTOR’S MODIFICATION PRICING MULTIPLIERS SCHEDULE – DATE OF AWARD THROUGH
COMPLETION OF ALL WORK
Description Percentage Rate Subcontractor Payment Bond Rate Subcontractor Performance Bond Rate Subcontractor General & Administrative (G&A) Rate Subcontractor Profit Rate Lower-Tier Subcontractor General & Administrative (G&A) Rate Lower-Tier Subcontractor Profit Rate
C. WORK CONTROL PRICING RATE SCHEDULE
The pricing rate provided in the table in Subsection D below are applicable to modifications requiring work control. The fixed-price hourly-rate applies to a single management-level representative to develop project-specific Work Control Packages. Work includes, but is not limited to, conducting the Job Hazard Analysis of the work, sequencing job steps, identifying required construction disciplines, scope of work verification, etc.
This individual must have signatory authority for the firm.
The SUBCONTRACTOR shall adhere to the pre-established Work Control rate for modifications. The CONTRACTOR shall review all SUBCONTRACTOR quotes to ensure compliance with contractual terms.
D. WORK CONTROL PRICING RATE – DATE OF AWARD THROUGH COMPLETION OF ALL WORK
Description Rate
Work Control Package Development Per Labor Hour
01/11/24 Page 4 of 17
E. SUBCONTRACT MODIFICATION SUMMARY LEVEL BREAKDOWN
As part of the SUBCONTRACTOR’S submittal for modification pricing, a summary level breakdown of labor, materials and equipment shall be included. The SUBCONTRACTOR shall provide the following information at a minimum, but not limited to:
1. Labor shall be listed by labor category, work description, unit of measure, quantity, hourly labor rate burdened and unburdened, a description of the burden categories and burden amounts (i.e., %), and extended total. This shall also include a written explanation of the basis for the estimated labor hours for each labor category.
2. Materials shall be listed by item, stock number where applicable, unit of measure, unit price, quantity, and extended total. Miscellaneous items shall be completely defined. This shall also include a written explanation of the basis for the estimated materials quantities for each material type.
3. Equipment shall be listed by item, model number where applicable, unit of measure (daily, weekly, monthly), unit price, quantity, and extended total. This shall also include a written explanation of the equipment needs.
4. Additional design if required shall include the price of preparation of all detailed drawings, engineering specifications, a material list, and submittal of design drawings for review. Provide breakdown of design prices for both Design – 60 % Draft (Title II) and Design – 100 % Complete (Title III). This shall also include a written explanation of the necessity for additional design work.
Pricing received from Lower-tier Subcontractor(s) by the SUBCONTRACTOR shall conform to the same requirements noted above.
Certified Cost or Pricing Data: In addition to the requirements stated herein, Subcontract modifications which are likely to exceed $2,000,000 shall be governed by FAR clause 52.215-13, Subcontractor Certified Cost or Pricing Data-Modifications. SUBCONTRACTOR shall submit certified cost or pricing data and certification as required by that clause.
F. MODIFICATION BUY AMERICAN CERTIFICATION
Buy American Certification will be included in each Modification Request for Quotation (RFQ) for certification by the awardee that all construction materials furnished under the modification are of domestic origin or otherwise in compliance with the Buy American Act.
3. TRAINING AND BADGING
CONTRACTOR-Provided Training: After award and before SUBCONTRACTOR personnel may commence any on-site work at CONTRACTOR facilities, all SUBCONTRACTOR personnel (including any lower-tier Subcontractor personnel) scheduled to perform activity level work on-site will be required to complete, at a minimum, CONTRACTOR-provided General Training and Work Control Training. The total amount of training time for each individual is estimated to be 4 hours. The CONTRACTOR will provide this training one time for all SUBCONTRACTOR on-site personnel prior to commencement of on-site work at no cost to the SUBCONTRACTOR. The estimated cost to the SUBCONTRACTOR for the time its on-site personnel will be required to take the initial training is included in the Firm-Fixed-Price specified herein for the performance of this Subcontract. If, due to turnover of trained personnel, the SUBCONTRACTOR needs additional training sessions during performance of the work for replacement personnel, the CONTRACTOR will provide the training but will not compensate the SUBCONTRACTOR for the time spent in training by the additional personnel to replace those personnel already trained.
Personnel who have previously completed NNSS General Training are not required to be re-trained if this training is current. Check with the Subcontract Technical Representative (STR) after award.
01/11/24 Page 5 of 17
4. PAYMENT TERMS
Enter any prompt payments discount or Net 30 Days .
Electronic funds transfer is the preferred method of payment used by Mission Support and Test Services, LLC. To take advantage of this expedited payment process, complete FRM-0870. Link to form:
http://www.nnss.gov/docs/docs_procurement/frm0870.pdf
5. MEASUREMENT FOR PAYMENT
A. Firm-Fixed-Price Milestone Payments
Milestone Payments shall be made for the successful completion of the Line Items identified as Milestone Payments in the Consideration Schedule, Exhibit A, Form A. Milestone Payments shall be made in accordance with clause D-6, Invoicing and Payment, and Clause D-7, Payments under Firm-Fixed-Price Construction Subcontracts (Exhibit D). All milestone payments and progress payments in the aggregate (as discussed below) for the subcontract shall be equal to the Total Firm-Fixed-Price identified in the Consideration Schedule.
B. Progress Payments Progress Payments shall be made as work progresses for the Line Items identified as Progress Payments below in the Consideration Schedule, Exhibit A, Form A, Progress Payments shall be made in accordance with Clause D-6, Invoicing and Payment, and Clause D-7, Payments under Firm-Fixed-Price Construction Subcontracts (Exhibit D). All progress payments and milestone payments in aggregate for the Subcontract shall be equal to the Total Firm-Fixed-Price identified in the Consideration Schedule for this Subcontract (or as identified in a Task Order, if applicable). Progress payments shall not exceed the corresponding values shown in the Schedule of Values (as discussed below):
C. Schedule of Values:
Within 10 days of award, the SUBCONTRACTOR shall submit a Schedule of Values to the Subcontract Administrator for review and approval. The Schedule of values must identify the major segments of the construction phase and the estimated cost to complete each segment. The estimated costs of the construction phase in aggregate must equal the line item for construction in the consideration schedule. The schedule of values will consist of the following segments at a minimum, but the Subcontract Administrator may require the SUBCONTRACTOR to break out the construction work into additional segments, as the Subcontract Administrator may determine necessary in their discretion.
6. Straight Time and Overtime: The foregoing rates shall apply to the first 40 hours of work performed in any one work week and to any overtime (any hours worked beyond 40 hours in any one week). NO ADDITIONAL COMPENSATION SHALL BE PAID BY CONTRACTOR TO SUBCONTRACTOR FOR OVERTIME. However, SUBCONTRACTOR shall not compensate its employee’s overtime at rates and conditions which are less than those prescribed by applicable law, regulations, executive orders, applicable collective bargaining agreements and the applicable terms and conditions of this Subcontract (including any applicable wage rate determinations attached hereto).
7. Travel to the Work Location: SUBCONTRACTOR shall not be paid for any time spent by its personnel for travel to and from the work location.
8. SUBCONTRACT VALUE
The Value of this Subcontract is To Be Determined dollars ($ To Be Determined). The total payments under this Subcontract shall not exceed Value of this Subcontract unless the value is modified by in writing by the Subcontract Administrator in advance.
http://www.nnss.gov/docs/docs_procurement/frm0870.pdf
01/11/24 Page 6 of 17
FORM B SUBCONTRACTOR AND VENDOR LIST
Subcontractor shall employ the following lower-tier subcontractors and/or vendors who will furnish major components, materials or equipment for performance of the work:
Name & Address
Work Description
Terms* Value Business Type *
If no lower-tier subcontracts or purchases are anticipated, enter the word “NONE.
NOTES: *
1. TERMS: Enter Lump Sum, Unit Price, etc.
2. Business Type: Enter SB for Small Business, SDB for Small Disadvantaged Business, WOSB for
Women-Owned Small Business, VOSB for Veteran-Owned Small Business, and SDVOSB for Service Disabled Veteran-Owned Small Business.
NOTE: This Form will become a part of the resultant subcontract.
01/11/24 Page 7 of 17
FORM C EVALUATION CRITERIA
1. CONTRACTOR intends to award a subcontract resulting from this Solicitation to the responsible OFFEROR whose proposal conforms to the solicitation. CONTRACTOR reserves the right to determine that proposals are outside the competitive range at any time during the evaluation process. OFFERORS whose proposals are determined to be outside the competitive range will be promptly notified.
In its sole discretion, CONTRACTOR may, but is not required to:
A. Accept or reject any proposal for any reason with or without prior discussions with the OFFEROR;
B. Waive any requirements of this solicitation or the Solicitation Documents or waive any noncompliance in any proposal;
C. Make award decisions on the basis of the information and proposals received from the OFFEROR and/or additional information received from other sources;
D. Select one or more competitive proposals for further technical review prior to award;
E. Make an award with or without discussions;
F. Obtain additional information of whatsoever nature from any OFFEROR for consideration in the award decision;
G. Amend this solicitation for any reason whatsoever;
H. Cancel this solicitation for any reason whatsoever;
I. Take any other action whatsoever in relation to this solicitation.
2. GENERAL CONSIDERATIONS
In addition to the evaluation of each OFFEROR’S proposal, CONTRACTOR will consider each OFFEROR’S adherence to the terms and conditions. All Exceptions and Deviations will be evaluated on a case-by-case basis. Exceptions and Deviations may result in the proposal not being selected for award.
3. EVALUATION METHOD
A. LOWEST PRICE TECHNICALLY ACCEPTABLE (LPTA)
This procurement will use a Pass/Fail process to assess the technical merits of the proposal. Technical aspects of the proposal will be evaluated to determine if the OFFEROR’s proposal meets the minimum criteria and solicitation requirements. Award will be made to the responsive, responsible OFFEROR on the basis of the lowest evaluated price of proposals meeting the acceptability standards specified in each criterion for non-cost factors unless no proposals are received which specify delivery by the required delivery date. In this event, CONTRACTOR reserves the right to make award to that responsive, responsible OFFEROR providing the earliest delivery whose proposal conforms to the solicitation and minimum standards/requirements specified for each criterion, price and other factors considered. Failure to satisfy any of the minimum standards/requirements for each criterion will result in the Proposal not being evaluated further and therefore the OFFEROR will be eliminated from consideration.
Pass - Meets the minimum requirements specified in each criterion.
Fail - Does not meet minimum requirements specified in each criterion.
01/11/24 Page 8 of 17
CRITERION 1: EXPERIENCE LEVEL
• OFFEROR and their partners should demonstrate their experience level in design-build projects for SCIF construction to include knowledge of ICD/IC 705 Standards for SCIF Construction. Proposal should include examples of past completed projects. Examples should reflect the project scope in construction techniques that are comparable to what is requested in the RFP.
CRITERION 2: SCHEDULE
• The OFFEROR should provide a preliminary project schedule that clearly identifies the OFFEROR’S plan for all work within the design, procurement, construction, commissioning, and contract close-out period of performance indicating a firm, fixed end-date of no later than September 30, 2024. The Preliminary project schedule should correspond to an 8-hour workday during normal business hours of operation (Monday – Friday, between 8am – 6pm), unless otherwise proposed by the OFFEROR. The schedule must include major milestones, deliverables, planned procurement activities, durations for each major work activity. The schedule should highlight required inspection activities and incorporate a timeline for the fabrication, testing, delivery of materials and equipment, OFFEROR pre-job trainings.
• The schedule shall be detailed enough for the CONTRACTOR to cross reference all milestones.
OFFEROR must receive a pass rating in all criteria to be considered for award.
B. PRICE EVALUATION:
CONTRACTOR will review pricing for completeness, reasonableness, and realism. The purpose of the review will be to ensure, to the maximum extent feasible, that OFFEROR’S proposed prices are complete and realistic in relation to the solicitation, and the technical proposals are reasonable in relation to known market pricing. Realism is the compatibility of the OFFEROR’S proposed price with proposal scope and required effort. Completeness is the responsiveness of the offer in providing the areas of price required by the RFP and scope of work. All the cost information required by the RFP must be submitted. An unrealistic price proposal may be grounds for eliminating a proposal from competition either on the basis that the OFFEROR does not understand the requirement or the OFFEROR has made an improvident proposal.
4. PREPARATION OF PROPOSAL (Technical and Pricing) Proposals shall be submitted on the forms furnished, or copies thereof, and must be manually signed. No erasures are permitted. If changes appear on the forms, the erroneous information must have a single line drawn through the information and be initialed and dated by the person signing the proposal.
Proposals must be submitted in separate volumes: [Technical and Price]. The proposal shall contain all pertinent information requested in sufficient detail to permit a thorough evaluation. If the requested information is not located in the proper section, the information may be considered omitted.
a. Proposals shall be submitted to arrive at this office by the date and time specified in the RFP cover letter.
b. Technical proposals submitted in response to this RFP shall comply with the criteria set forth in paragraph 3 above.
c. Format and Content
OFFEROR shall include in its proposal the following:
Volume 1 – Technical information should clearly address each of the technical proposal evaluation criteria in paragraph A above. It should be presented in as much detail as practical and include the following as a minimum:
1. Criterion 1: Experience Level
2. Criterion 2: Schedule
01/11/24 Page 9 of 17
3. Form B – Subcontractor and Vendor List without Prices
4. Form D – Experience Statement completed
5. Form E – Lower Tier Subcontractor Experience Statement
6. Form F – Resumes of Key Personnel
7. Form H – Safety Program
8. Form I – Subcontractor Safety and Health History
9. Form J – Lower-Tier Subcontractor Safety and Health History
10. Form K – Subcontract Schedule
Volume 2 – Pricing proposal shall include completed:
1. OFFEROR’S Proposal Letter, signed and dated
2. Collective Bargaining Agreement – Letter of Assent
3. Form A – Consideration Schedule in its entirety,
4. Form B – Subcontractor and Vendor List with Prices
5. FRM-0870, W-9
Note 1: Provide one (1) electronic file copy Volume 1 Technical Proposal, one (1) electronic file copy Volume 2 Price Proposal to CONTRACTOR for evaluation. All information shall be printed single sided and shall not be a duplicate to ensure clarity of words and/or images.
Note: This Form is for evaluation purposes only and will not be a part of the resultant subcontract.
01/11/24 Page 10 of 17
FORM D EXPERIENCE STATEMENT
The OFFEROR submits the following statement as to its experience qualifications. In the case of a joint venture, separate forms will be submitted for previous experience of the joint venture and the experience of each party of the joint venture.
This company has been engaged in the contracting business under its present business name for years.
Experience in work of a nature similar in type and magnitude to that set forth in the Statement of Work (SOW) extends over a period of years.
All awarded contracts have been satisfactorily completed, except as follows (name any and all exceptions and reasons therefore, attaching additional pages if necessary):
The following contracts, covering work similar in type and magnitude to that set forth in the SOW, have been satisfactorily completed within the last 5 years preceding the due date for proposals specified in the solicitation or are now in progress for the following owners or prime contractors.
NAME, ADDRESS/CONTACT AND
TELEPHONE NUMBER
WORK
DESCRIPTION
VALUE LOCATION START/STOP
01/11/24 Page 11 of 17
FORM E LOWER-TIER SUBCONTRACTOR EXPERIENCE STATEMENT
This statement of experience qualifications is submitted for the following lower-tier subcontractor or supplier. In the case of multiple lower-tier subcontractors or suppliers, separate forms will be submitted for previous experience of each lower-tier subcontractor or supplier.
COMPANY NAME: PHONE:
CONTACT: FACSIMILE:
ADDRESS:
This company has been engaged in the contracting business under its present business name for years.
Experience in work of a nature similar in type and magnitude to that set forth in the SOW extends over a period of years.
All awarded contracts have been satisfactorily completed, except as follows (name any and all exceptions and reasons therefore, attaching additional pages if necessary):
The following contracts, covering work similar in type and magnitude to that set forth in the SOW, have been satisfactorily completed within the last 5 years preceding the due date for proposals specified in the solicitation or are now in progress for the following owners or prime contractors.
NAME, ADDRESS/CONTACT AND
TELEPHONE NUMBER
WORK
DESCRIPTION
VALUE LOCATION START/STOP
01/11/24 Page 12 of 17
FORM F PROJECT ORGANIZATION DESCRIPTION
OFFEROR is to attach an organizational chart with numbers and titles of key personnel and numbers and categories of home office personnel. Additionally, the OFFEROR is to provide a written description of the organization, defining lines of authority/responsibility/communication and the overall working of the organization with particular emphasis on interface and the procedures for monitoring and controlling the work.
OFFEROR is to attach a narrative, not to exceed three pages, describing its plan for Subcontract execution. This plan should be developed in conjunction with the organizational chart, resumes, and proposed lower-tier subcontractors/vendors. The narrative shall explain the management approach to this project as well as the flow of work from start to conclusion.
OFFEROR also must include capacity to perform information that links directly to each function listed on the organizational chart (i.e., the name of the person and the percentage of utilization in the program).
01/11/24 Page 13 of 17
FORM G RESUMES OF KEY PERSONNEL
OFFEROR is to provide a resume for each key person to be assigned to the Subcontract, containing at least the following information on each person.
1. TITLE:
2. NAME:
3. EDUCATION/QUALIFICATIONS:
4. PRESENT POSITION IN OFFEROR’S COMPANY:
5. RELEVANT EXPERIENCE:
6. EMPLOYMENT HISTORY:
7. CITIZENSHIP:
Attach and properly designate additional pages, if necessary.
NOTE: This Form is for evaluation purposes only and will not be a part of the resultant subcontract.
Approved personnel listed in the Special Condition titled “Approval of SUBCONTRACTOR Key Personnel” may not be replaced without CONTRACTOR’s approval of the replacement personnel.
01/11/24 Page 14 of 17
FORM H SAFETY PROGRAM
OFFEROR shall submit the following Safety and Health data with its proposal:
Environmental Safety & Health Requirements:
The SUBCONTRACTOR’s commitment to Environmental Safety and Health will be evaluated on their written
Safety Management Program as represented by the company’s written safety programs, policies, procedures, and understanding of requirements and safe job performance through:
Work Definition Hazard Identification & Control Hazard Performing Work Safely Self-Improvement Worker Training
Additional Information for evaluation purposes:
Resume of Company Safety Manager Resume of proposed Site Safety Representative (see Attachment A for qualification requirements) Completed Health History Forms
Subcontractor Lower-Tier Subcontractors
Insurance EMR verification for past three (3) years Subcontractor Lower Tier Subcontractors
Note: An Experience Modification Rate (EMR) of 1.0 or less is acceptable (Pass). If an EMR exceeds 1.0 for any year, the SUBCONTRACTOR and/or their LOWER-TIER SUBCONTRACTORS shall:
a. Supply information that clearly and completely explains the excessive rate(s)
b. Provide objective evidence that the root cause(s) of the excessive rate(s) have been identified and corrective actions implemented that have resulted in measurable improvements in safety performance, e.g.
lower incident rates, less severe incidents, and subsequent reductions in the EMR.
Pertinent information will be written into the appropriate Subcontract documents.
01/11/24 Page 15 of 17
FORM I SAFETY AND HEALTH HISTORY
Submittals:
1. Company Safety Program/applicable procedures
2. Resume of Company Safety Manager
3. Resume of proposed Site Safety Representative (reference Attachment A, Qualification Requirements for Safety Representative)
4. Insurance EMR verification
1. General Subcontractor Name:
2. NAICS Code: 236220 Commercial and Institutional Building Construction
3. Number of Lower-Tier Subcontractors expected on-site?
4. Lower-Tier Subcontractor Name Discipline:
5. Workers’ Compensation Insurance Carrier letter providing your firm’s Interstate EMR for the three
(3) most recent years. Attach letter and input rates and total hours worked.
Year: EMR: Insurance Carrier:
Year: EMR: Insurance Carrier:
Year: EMR: Insurance Carrier:
6. Number of OSHA Inspections previous 5 years. Year(s):
7. Number of OSHA Citations previous 5 years Type:
8. Use your OSHA 300 Log to fill in number of injuries and illnesses for previous three years:
a) Number of lost workday cases Year:
# Hours Worked:
b) Number of restricted workday cases Year:
# Hours Worked:
c) Number of cases with medical attention only
Year:
# Hours Worked:
d) Number of fatalities Year:
# Hours Worked:
9. Explanation for EMR if greater than 1.0 :
01/11/24 Page 16 of 17
FORM J LOWER-TIER SUBCONTRACTOR SAFETY AND HEALTH HISTORY
1. Lower-Tier Company Name:
2. NAICS Code: 236220
Commercial and Institutional Building Construction
3. Name of General Subcontractor
4. Workers’ Compensation Insurance Carrier letter providing your firm’s Interstate EMR for the three
(3) most recent years. Attach letter and input rates and total hours worked.
Year: EMR:
Year: EMR:
Year: EMR:
5. Use your last year’s OSHA No. 300 Log to fill in number of injuries and illnesses:
a) Number of lost workday cases
Hours Worked:
b) Number of restricted workday cases
c) Number of cases with medical attention only
d) Number of fatalities
6. Number of OSHA Inspections previous 5 years. Year(s):
7. Number of OSHA Citations previous 5 years Type: (De minimus, Serious, Willful, Repeat)
8. Do you have a written safety program? Yes No
9. Have you submitted the safety program to the General Contractor for their approval? Yes No
10. Explanation for EMR greater than 1.0
01/11/24 Page 17 of 17
FORM K SUBCONTRACT SCHEDULE
OFFEROR is to submit a Preliminary Subcontract Schedule in the Critical Path Method (CPM) format addressing as a minimum the milestone dates listed in the Special Condition titled “COMMENCEMENT, PROSECUTION AND COMPLETION OF THE WORK.”
WORK ACTIVITY WEEK 1 2 3 4 5 6 7 8 9 10 11
WORK ACTIVITY WEEK 12 13 14 15 16 17 18 19 20 21 22
NOTES:
Continue on additional sheets if necessary.
| Form A Consideration Schedule 2 |
| Form B Subcontractor and Vendor List 6 |
| Form C Evaluation Criteria 7 |
| Form D Experience Statement 10 |
| Form E Lower-Tier Subcontractor Experience Statement 11 |
| Form F Project Organization Description 12 |
| Form G Resumes of Key Personnel 13 |
| Form H Safety Program 14 |
| Form I Safety and Health History 15 |
| Form J Lower-Tier Subcontractor Safety and Health History 16 |
| Form K Subcontract Schedule 17 |
| Form A Consideration Schedule |
| Form B Subcontractor and Vendor List |
| Form C Evaluation Criteria |
| Form D Experience Statement |
| Form E Lower-Tier Subcontractor Experience Statement |
| Form F Project Organization Description |
| Form G Resumes of Key Personnel |
| Form H Safety Program |
| Form I Safety and Health History |
| Form J Lower-Tier Subcontractor Safety and Health History |
| Form K Subcontract Schedule |
File details come from the government source that posted it. Updated .