506-17-503 Contractor EMR Certification Form 2020.docx
DOCX document 15 KB Posted
- Attached to
- Z1DA--506-17-503 Chiller Plant Optimization Federal contract opportunity
- Solicitation number
- 36C25020B0063
About this file
This document contains a pre-solicitation announcement and related federal contract opportunity notice for construction services. The Department of Veterans Affairs VA Medical Center in Ann Arbor, Michigan will issue an Invitation for Bid on June 10, 2020 through the Federal Business Opportunities website for project 506-17- Chiller Plant Optimization. The scope of work involves improving the performance of three existing water-cooled centrifugal chillers in the central chiller plant including rerouting primary and secondary chilled water piping, tying cooling tower basins together, coating tower interiors, and modifying controls to improve efficiency and reduce manpower. The contract will have a firm fixed price, 270 calendar days for completion, NAICS code 238990, and value between $500,000 and $1,000,000. The solicitation, specifications and drawings will be available for download at no cost from beta.SAM.gov as of June 10 with the IFB due date specified therein.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25020B0063 0003.docx | DOCX document | |
| 36C25020B0063 0002.docx | DOCX document | |
| Covid Instructions.docx | DOCX document | |
| 506-17-503 RFI.docx | DOCX document | |
| 36C25020B0063 0001.docx | DOCX document | |
| 506-17-503 Drawing -Building 32 - Pipping Plan.pdf | ||
| Pre-Bid Attendance.pdf | ||
| Specification -STRUCTURAL STEEL FRAMING.docx | DOCX document | |
| 506-17-503 Drawing - Building 32 - Roof Level.pdf | ||
| Ann Arbor Chiller Plant Optimization - Project RFI Questions r1.pdf | ||
| 36C25020B0063.docx | DOCX document | |
| WD MI20200100 rev 7-10-2020.txt | TXT text file | |
| 506-17-503 - Specifications.pdf | ||
| 506-17-503 PM_Part808.405-6_Atch1_Limiting_Sources_Justification_MPT-SAT - Siemens (003)- CORRECTED.pdf | ||
| S02 - RFI Form 506-17-503.docx | DOCX document | |
| 506-17-503 Drawings.pdf |
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Text version
Pre-Award Contractor Experience Modification Rate (EMR) Form
Information regarding your EMR is being sought in conjunction with your offer applicable to Solicitation 36C25020B0063 to assist in making an initial determination of responsibility for any potential awardee in accordance with FAR 9.104-1(e) which states that “to be determined responsible, a prospective contractor must have the necessary organization, experience, accounting and operational controls, and technical skills including safety programs applicable to materials to be produced or services to be performed by the prospective contractor and subcontractors.”
Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information for the past three calendar years:
| Category |
| 2016 |
| 2017 |
| 2018 |
| 2019 |
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.
2. Please attach copies of the following documents: 2019 OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page: http://www.osha.gov/pls/publications/publication.html.
3. Provide six-digit North American Industrial Classification System (NAICS) Code for this acquisition: __________________________________
4. The name and title of the person who administers your company’s Safety and Health Program? ____________________________.
5. Your company’s Insurance Experience Modification Rate (EMR): ______
File details come from the government source that posted it. Updated .