Attachment 1 - Experience Modification Rate Form.pdf
PDF 161 KB Posted
- Solicitation number
- 36C24725R0071
About this file
This is an Experience Modification Rate (EMR) Form that contractors must complete and return with their response to solicitation 36C24725R0071 for boiler plant deficiency corrections at VA Building 14. The form requires contractors to provide three years of safety performance data (2022-2024) from their OSHA 300 Forms, including total man-hours worked, number of cases involving days away from work or restricted activity, DART rate calculations, and any OSHA violations within the past 3 years.
The form requires contractors to attach OSHA 300 and 300a Forms and provide their company's Insurance EMR for the past 3 years. Notably, contractors will be disqualified if they have four serious violations, one repeat violation, or one willful violation from OSHA within the last 3 years. The government will use this information along with OSHA and EPA online inspection history databases to verify the contractor meets the EMR requirements specified in the solicitation.
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| 36C24725R0071 0002.docx | DOCX document | |
| 36C24725R0071 0001.docx | DOCX document | |
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| Attachment 8b - Specs - Vol 2.pdf | ||
| Attachment 5 - DBA Wages AL20250093 01-03-2025.pdf | ||
| Attachment 4 - Itemized Cost Breakdown.xlsx | XLSX spreadsheet | |
| Attachment 2 - VAAR 852.219-75 VA Notice of Limitations on Subcontracting Jan 2023 Dev.pdf | ||
| 36C24725R0071 Solicitation.docx | DOCX document | |
| Attachment 3 - Past Performance Questionnaire -PPQ.docx | DOCX document | |
| Attachment 8c - Specs - Vol 3.pdf | ||
| Attachment 8a - Specs - Vol 1.pdf | ||
| Attachment 7 - Combined Drawings 619-20-103.pdf | ||
| Attachment 6 - Invoicing.docx | DOCX document |
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Text version
Attachment 1 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:
Category 2022 2023 2024 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.
http://www.osha.gov/pls/publications/publication.html VHAV07PowerJ1 Cross-Out
File details come from the government source that posted it. Updated .