8. VA DIRECTIVE 7715 EMR 02 FORM.docx
VA Directive DOCX document 16 KB Posted
- Solicitation number
- 36C26124R0020
About this file
This document is a contractor certification form required as part of a Request for Proposal (RFP) for a construction project to renovate the outpatient pharmacy and HVAC system at the VA Northern California Healthcare System in Mather, CA.
The key details are:
- The contractor must have no more than 3 serious, 1 repeat, or 1 willful OSHA or EPA violations in the past 3 years, and an Experience Modification Rate (EMR) of 1.0 or less to be eligible for award.
- The project will renovate and upgrade the HVAC and mechanical systems for the outpatient pharmacy space, and provide construction drawings for temporary pharmacy operations during the renovation. The period of performance is estimated at 426 days from notice to proceed.
- This is a task order RFP set aside for VISN 21 MACC Group 2 contract holders. The government contemplates award of a firm-fixed price construction contract.
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Other versions and copies of VA Directive 7715
| File | Revision | Posted | Attached to |
|---|---|---|---|
| 18 - Safety VA Directive 7715 Rev 092023.pdf | Revision not stated | Y1DA--9th Floor MH Renovation WBVAMC | |
| Attachment - VA DIRECTIVE 7715 EMR 02 FORM.pdf | Revision not stated | Z2DA--Replace Flooring in OR, PACU, and Special Procedures |
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Text version
PER VHA DIRECTIVE 7715 (06 April 2017) - SAFETY & ENVIRONMENTAL RECORD AND EXPERIENCE MODIFICATION RATE (EMR):
Contractor Certification Regarding Project:
To be eligible for consideration and award, the contractor shall have no more than three serious, or one repeat, or one willful OSHA or EPA violation(s) in the past 3 years and have an EMR of equal to or less than 1.0.
All Offerors shall submit the following information pertaining to their past Safety & Environmental Record and EMR with their offer.
1. SAFETY & ENVIRONMENTAL RECORD: A self-certification on company letterhead that the contractor has no more than three (3) serious, or one (1) repeat or one (1) willful OSHA or any EPA violation(s) in the past three years.
2. EMR: All Offerors shall submit information regarding their current EMR. This information shall be obtained from the Offerors’s insurance carrier and be furnished on the insurance carrier’s letterhead. If an Offeror’s EMR is above 1.0, Offeror shall submit a written explanation of the EMR from its insurance carrier furnished on the insurance carrier’s letterhead, describing the reasons for the EMR, and the anticipated date the EMR may be reduced to 1.0 or below.
| 2022 |
| 2023 |
| 2024 |
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.)
Number of violations from EPA within the last 3 years. Please attach explanation for any violations.
Company’s Current Insurance Experience Modification Rate (EMR) = (Note: Contractor must support the EMR with a signed letter from Insurance Carrier on their letterhead.)
Signature:
Print Name: _________________________________________________
File details come from the government source that posted it. Updated .