Attachment 004 Contractor Certification Regarding EMR.docx
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- Solicitation number
- 12805B24R0032
About this file
This document is an Attachment 004 Contractor Certification Regarding EMR related to Solicitation 12805B24R0032 for Boiler Chiller and Fuel Oil System Upgrades in Manhattan, Kansas.
The key details are:
- Offerors must submit information on their past safety and environmental record, including certification that they have no more than three (3) serious, one (1) repeat or one (1) willful OSHA or EPA violations in the past three years.
- Offerors must submit their current Experience Modification Rate (EMR) from their insurance carrier or from the National Council on Compensation Insurance (NCCI) if self-insured. If the EMR is above 1.0, the offeror must submit a written explanation from the insurance carrier.
- This information, along with other sources, will be used to make an initial Determination of Responsibility.
- The requirement applies to all subcontracting tiers.
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Text version
Attachment 004 Contractor Certification Regarding EMR Solicitation 12805B24R0032
Instructions: Complete form, save as pdf with digital signature and submit all required documents with offer
L.6 SAFETY OR ENVIRONMENTAL VIOLATIONS AND EXPERIENCE MODIFICATION RATING
1. All Offerors shall submit information pertaining to their past Safety and Environmental record. (using the attached EMR information and certification form) pertaining to their past Safety and Environmental record. The information must contain a certification that the offeror 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. All Offerors shall submit information regarding their current Experience Modification Rate (EMR). This information shall be obtained from the Offeror’s insurance carrier and be furnished on the insurance carrier’s letterhead. If an Offeror’s EMR is above 1.0, Bidder/Offeror must submit a written explanation of the EMR from its insurance carrier furnished on the insurance carrier’s letterhead, describing the reasons for the elevated EMR and the anticipated date the EMR may be reduced to 1.0 or below.
3. Self-insured contractors or other contractors that cannot provide their EMR rating on insurance letterhead obtain a rating from the National Council on Compensation Insurance, Inc. (NCCI) by completing/submitting form ERM-6 and providing the rating on letterhead from NCCI. Note: Self-insured contractors or other contractors that cannot provide EMR rating on insurance letterhead from the states or territories of CA, DE, MI, NJ, ND, OH, PA, WA, WY, and Puerto Rico shall obtain their EMR rating from their state run worker’s compensation insurance rating bureau.
4. If the NCCI cannot issue an EMR because the Offeror lacks insurance history, Offeror shall submit a letter indication so from its insurance carrier furnished on the insurance carrier’s letterhead, and include a letter from the NCCI indicating that it has assigned Offeror a Unity Rating of 1.0.
5. The above information, along with other information obtained from Government systems, such as the OSHA EPA online inspection history databases, will be used to make an initial Determination of Responsibility.
6. This requirement is applicable to all subcontracting tiers, and prospective prime contractors are responsible for determining the responsibility of their prospective subcontractors.
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Number of serious, willful, or repeat violations from OSHA within the last 4 years. Please attach explanation for any violations. (Three serious, one repeat, or one willful violation shall result in being determined non- responsible.)
Company’s Current Insurance Experience Modification Rate (EMR) =
Signature:
Typed Name:
Title:
File details come from the government source that posted it. Updated .