Attachment 006 Contractor Certification Regarding EMR.docx

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Attached to
Office and Lab Remodel - Fargo ND
Solicitation number
12805B23R0024
Issued by

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This document is an attachment to a federal solicitation requesting certification from contractors regarding their experience modification rate and any OSHA violations. The solicitation is for an office and lab remodel project located in Fargo, North Dakota, issued by the Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery Plains Area. Bidders must disclose the number of serious, willful, or repeat OSHA violations in the past four years and provide an explanation for any violations, as three serious, one repeat, or one willful violation will result in a determination of non-responsibility. Contractors must also disclose their current insurance experience modification rate and provide supporting documentation from their insurance carrier. The attachment requires the contractor's signature, printed name, title, and certification of the above details regarding safety violations and modification rates.

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Other files

File Type Posted
Q_A RFP 12805B23R0024 Office and Lab BRL 200 Wing Remodel.pdf PDF
Amd 0001 RFP 12805B23R0024 Clauses and Provisions.pdf PDF
SF30 AMD 0001_12805B23R0024.pdf PDF
Attachment 009 12805B23R0024 Site Visit Information.docx DOCX document
Attachment 003 Office and Lab Design Analysis.pdf PDF
Attachment 008 Pre-Award Survey Form.docx DOCX document
Attachment 004 Office and Lab Drawings.pdf PDF
Attachment 001 Wage Determination.pdf PDF
RFP 12805B23R0024 Office and Lab Remodel.pdf PDF
Attachment 005 Office and Lab Bid Schedule.pdf PDF
Attachment 007 SAM Reps and Certs Form.docx DOCX document
Attachment 002 Office and Lab Specifications.pdf PDF
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Contractor Certification Regarding Project: 12805B23R0024

2018
2019
2020
2021

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) =

(Note: Contractor must support the EMR with a signed letter from Insurance Carrier on their letterhead.)

Signature:

Typed Name:

Title:

File details come from the government source that posted it. Updated .