ATTACHMENT 19 - Contractor Safety and Env. Form.docx
DOCX document 14 KB Posted
- Attached to
- Z2DZ--Demolish CLC Building D - Atlanta
- Solicitation number
- 36C77621R0007
About this file
This solicitation package includes a contractor safety evaluation form and details of a federal contract opportunity. The solicitation seeks proposals for the design-build demolition of a 103,000 square foot, three story concrete and steel structure nursing home facility located at the Atlanta VA Medical Center. Offerors must provide working drawings, specifications, and demolition services for the building potentially including architectural, structural, civil, mechanical, plumbing, fire suppression, electrical, and environmental remediation systems. The period of performance is approximately 540 calendar days from notice to proceed. The solicitation will be issued as a request for proposal evaluated according to FAR Part 36.3 for design-build selections. It is set aside as a total SDVOSB and will be issued in mid to late November 2020 with a value between $2,000,000 to $5,000,000. Offerors must complete the attached contractor safety evaluation form providing OSHA record and rate data from 2016 to 2019.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77621R0007 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2016 |
| 2017 |
| 2018 |
| 2019 |
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.
File details come from the government source that posted it. Updated .