506-18-102 Contractor EMR Certification Form 2020.docx
DOCX document 15 KB Posted
- Attached to
- Z1DA--506-18-102 Upgrade Electrical Switchgear Distribution Federal contract opportunity
- Solicitation number
- 36C25020B0057
About this file
This pre-solicitation announcement and related federal contract opportunity document provide details for solicitation number 36C25020B0057 to upgrade electrical switchgear and distribution at the Department of Veterans Affairs Medical Center in Ann Arbor, Michigan. The VA seeks a contractor to replace the facility's outdated 4,800V primary distribution system with a new 13.2kV system for $2-5 million. The successful offeror will have 570 days to furnish all labor, tools, equipment, and supervision necessary to install the new distribution infrastructure per plans and specifications. Interested parties must register at beta.SAM.gov and carefully review solicitation documents for mandatory requirements, work scope, and a July 2020 bid due date when full solicitation details are published. Offerors must complete annual representations and ensure active SAM and VetBiz registrations to be considered for this project supporting the VA Medical Center in upgrading its electrical infrastructure.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Covid Instructions.docx | DOCX document | |
| Pre-Bid Attendance 506-18-102.pdf | ||
| 506-18-102 - RFIs answers.docx | DOCX document | |
| 36C25020B0057 0001.docx | DOCX document | |
| 506-18-102 Specs Vol 1 - Ann Arbor VA Upgrade Switchgear.pdf | ||
| 36C25020B0057_3.docx | DOCX document | |
| 506-18-102 Specs Vol 2 - Ann Arbor VA Upgrade Switchgear.pdf | ||
| _WD MI20200100 7-24-20.pdf | ||
| 506-18-102 Upgrade Electrical Swithgear Bid Set.pdf | ||
| RFI Form 506 18 102.docx | DOCX document |
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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 .