Attachment 4 Contractor Certification Regarding EMR.docx
DOCX document 14 KB Posted
- Attached to
- Vivarium Floor Replacement Federal contract opportunity
- Solicitation number
- 12805B23R0011
About this file
This document contains an attachment regarding a contractor certification for a federal solicitation. The solicitation number is 12805B23R0011 for a vivarium floor replacement project. The contractor certification attachment requests information on any OSHA violations from the past four years and the contractor's current insurance experience modification rate, to be supported by a signed letter from the contractor's insurance carrier. The solicitation and attachments can be found under number 12805B23R0011. A mandatory site visit is scheduled for an unspecified location, date, and time. The soliciting agency is the Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery Plains Area.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Sol_12805B23R0011_Amd_0003.pdf | ||
| Wage Determination ND20230014.pdf | ||
| QA 12805B23R0011.docx | DOCX document | |
| Sol_12805B23R0011_Amd_0002.pdf | ||
| SOW - Vivarium Floor Replacement - Grand Forks ND 1-09-23.docx | DOCX document | |
| Sol_12805B23R0011_Amd_0001.pdf | ||
| Solicitation_12805B23R0011.pdf | ||
| Attachment 5 Pre-Award Survey Form.doc | DOC document | |
| Attachment 2 BC23-TG69 Flooring System Spec Sheet.pdf | ||
| Attachment 6 SAM Reps and Certs Form.docx | DOCX document | |
| Attachment 3 Scope of Work.docx | DOCX document | |
| Attachment 1 Wage Determination ND2015-4973.pdf |
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Text version
Contractor Certification Regarding Project: 12805B23R0011
| 2019 |
| 2020 |
| 2021 |
| 2022 |
Number of serious, willful, or repeat violations from OSHA within the last 4 years. Please attach explanation for any violations. (Three serious, one repeat, or one willful violation shall 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 .