Attachment 1_Experience Modification Rate.pdf
PDF 79 KB Posted
- Solicitation number
- 36C24726R0028
About this file
This is an Experience Modification Rate Form for RFP No. 36C24726R0028 that offerors must complete and return with their solicitation responses.
The form requires offerors to provide company identification information (name, address, telephone, email, and contact person) and complete a three-year safety history table covering 2023, 2024, and 2025. Offerors must document the number of man hours worked at jobsites and offices, the number of OSHA 300 Form cases involving days away from work or restricted activity (DART Rate cases), calculate the DART Rate using the formula of cases multiplied by 200,000 divided by man hours, and report the number of serious, willful, or repeat OSHA violations from the past three years with explanations. The form specifies that four serious violations, one repeat violation, or one willful violation disqualifies the contractor. Offerors must also provide their company's insurance Experience Modification Rate (EMR) for the past three years and attach copies of OSHA 300 and 300a Forms. The government will use the submitted information along with data from OSHA and EPA online inspection history databases to verify that contractors meet the Experience Modification Rate threshold specified in the solicitation.
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Attachment 1- RFP No. 36C24726R0028 Experience Modification Rate Form
Offeror To Complete & return with response to solicitation
Company Name: --------------------------------
Address:
Telephone: Email:
Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
2024 2025 Category 2023
Number of man hours (jobsite and office).
Number of cases involving days away from work, restricted activity, or both (Column H and I of OSHA 300).
Days away, restricted, or transferred rate(# of days away, restricted, or transferred cases x 200,000/# of man hours) (DART Rate).
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.)
Please attach copies of the following documents: OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page: http://www.osha.gov/pls/publications/publication.html.
2. Company's Insurance Experience Modification Rate (EMR) for the past 3 years :
The above information, along with other information obtained from Government systems, such as the OSHA and EPA online inspection history databases will be used to ensure the contractor meets Experience Modification Rate indicated in the solicitation.
File details come from the government source that posted it. Updated .