Attachment 4 Contractor Certification Regarding EMR.docx

13 KB Posted

Attached to
Roofing IDIQ - Plains Area - North
Solicitation number
12805B21R0002
Issued by

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Contractor Certification Regarding Project: Plains Area Roofing IDIQ

2017
2018
2019
2020

Number of serious, willful, or repeat violations from OSHA within the last 4 years. Please attach explanation for any violations. (Four serious, one repeat, or one willful violation could 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 .