Attachment 3 -Contractor EMR Certification Form.pdf
PDF 89 KB Posted
- Attached to
- Install Car Charging Stations Project #539-21-203 at the Cincinnati VAMC, Cincinnati, OH
- Solicitation number
- 36C25021B0013
About this file
This document includes a pre-award contractor safety and environmental record evaluation form as well as details for a federal contract opportunity to install car charging stations at two Veterans Affairs medical centers in Ohio. The pre-award form requests information on the contractor's man-hours, OSHA recordable incidents, daily average recordable rate, and serious violations over the past three years. It also asks for the contractor's NAICS code and who administers its safety program. The federal contract opportunity is to install car charging stations at the Cincinnati and Fort Thomas VA medical centers with an estimated value between $5-10 million. The response due date is in March 2021 and the period of performance is 180 calendar days. This opportunity is 100% set aside for service-disabled veteran-owned small businesses.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25021B0013 0005.docx | DOCX document | |
| 36C25021B0013 0004.docx | DOCX document | |
| SD321216-02.pdf | ||
| SD321216-01.pdf | ||
| 36C25021B0013 0003.docx | DOCX document | |
| 36C25021B0013 0002.docx | DOCX document | |
| 539-21-203_ ADDENDUM_1-write up -2021.0304.pdf | ||
| 539-21-203 drawings -addendum1 2021.03.pdf | ||
| 36C25021B0013 0001.docx | DOCX document | |
| Site Visit 2.24.2021.pdf | ||
| 36C25021B0013_1.docx | DOCX document | |
| Attachment 2- SPECIFICATONS.pdf | ||
| Attachment 1 - DRAWINGS.pdf | ||
| Attachment 5-DBA-WD-OH020210082.pdf | ||
| Attachmetn 4- RFI Form.pdf |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Solicitation #36C25021B0013:
Company Name:
Address:
Telephone: Fax:
Email:
Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2018 2019 2020
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.
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. Provide six-digit North American Industrial Classification System (NAICS) Code for this acquisition: 236220
3. Who administers your company’s Safety and Health Program?
4. Company’s Insurance Experience Modification Rate
(EMR):
http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .