Contractor_Certification_Regarding_EMR.pdf
PDF 27 KB Posted
- Attached to
- REPLACE ELEVATOR SINGLE-BOTTOM CYLINDER Federal contract opportunity
- Solicitation number
- AG-32SD-S-17-0002
About this file
Contractor Certification Regarding EMR
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Pre-bid_Construction_Sign_In_Sheet.pdf | ||
| AG-32SD-S-17-0002_001.pdf | ||
| Specifications.pdf | ||
| Calculation_of_Self_Performed_Work.pdf | ||
| Wage_Determination_UT160103_10-07-2016_UT103.pdf | ||
| AG-32SD-S-17-0002.pdf | ||
| RFI_FORM.pdf | ||
| Drawings.pdf |
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Text version
Contractor Certification Regarding Project: REPLACE ELEVATOR SINGLE-BOTTOM
CYLINDER
2012 2013 2014 2015 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 violation could result in being determined non-responsible.)
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: ______________________________________________
Typed Name: ______________________________________________________
Title: ______________________________________________________
Contractor Certification Regarding Project: REPLACE ELEVATOR SINGLE-BOTTOM CYLINDER
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