6-Attachment E - Safety Documents.pdf
PDF 315 KB Posted
- Solicitation number
- 26RFP033
- Issued by
- Travis County, Austin City, Texas
About this file
This file is Attachment E from a Request for Proposals issued by the Austin Independent School District (AISD) in Texas for Custom Walk-In Refrigeration Units, and it establishes the safety documentation requirements that bidding vendors must submit. Bidders are required to provide OSHA 300 Logs and 300A Summary Form Logs for the last three completed calendar years, with the 300A Summary Form required for every year even if no recordable injuries occurred. Additionally, vendors must submit a loss run (statement of claims) from their workers' compensation insurance carrier covering the most recently completed policy year, printed no more than 60 calendar days before the bid due date, with claimant names permitted to be redacted. If no losses have occurred, vendors must provide documentation from their insurance carrier confirming zero losses.
Vendors are also required to submit a loss ratio from their workers' compensation insurance carrier for the most recently completed policy year, with the corresponding time period clearly indicated and printed within 60 calendar days of the bid submission deadline. The loss ratio must be provided directly by the insurance carrier or agency with the company name clearly legible; typed or handwritten loss ratios prepared internally by the firm will not be accepted. Finally, bidders must provide their organization's current experience modifier from their workers' compensation insurance premiums, issued by the insurance carrier, agent, or rating agency with the applicable year clearly indicated and printed no more than 60 calendar days prior to the bid due date. All insurance documents must display the insurance carrier or agency name legibly and include clearly marked print dates to verify compliance with the 60-calendar-day requirement.
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Attachment E
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.
Attachment B
-- 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.
Attachment B
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
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