Attachment 04 - Contractor Certification Regarding EMR.pdf
PDF 225 KB Posted
- Attached to
- Construct Exterior Dirt Floor Pens Federal contract opportunity
- Solicitation number
- 12805B23R0020
About this file
This attachment is a contractor certification form related to Solicitation Number 12805B23R0020 from the Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery Plains Area to construct exterior dirt floor pens.
The contractor certification form requests information on the number of serious, willful, or repeat violations from OSHA within the last 4 years and an explanation for any violations, as three serious, one repeat, or one willful violation will result in a determination of non-responsibility. It also requests disclosure of the contractor's current insurance experience modification rate and support for this rate through a signed letter from the contractor's insurance carrier on their letterhead.
The related solicitation seeks to construct exterior dirt floor pens and indicates that the solicitation and attachments should be reviewed. It provides the location, time and date for an optional site visit for offerors.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 2023.06.02 RFI-2 - Questions and Answers.pdf | ||
| Site visit sign in sheet.pdf | ||
| RFI-1 Questions and Answers from site visit May 18 2023.pdf | ||
| Attachment 01 - Summary of Work_Specifications 20220516-FINAL.pdf | ||
| Attachment 02 - Wage Determination.pdf | ||
| Solicitation - 12805B23R0020.pdf | ||
| Attachment 06 - ARS-372 Request for Payment.pdf | ||
| Attachment 03 - Bond Forms.pdf | ||
| Attachment 05 - ARS 371 Construction Progress and Payment Schedule.pdf |
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Text version
ATTACHMENT 4
Contractor Certification Regarding Project: 12805B23R0020
2019 2020 2021 2022 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 .