Attachment 4 Contractor Certification Regarding EMR.docx
DOCX document 14 KB Posted
- Attached to
- Wind Break for Barn 6 Federal contract opportunity
- Solicitation number
- 12805B22R0022
About this file
This document contains a contractor certification form and details of a related federal contract opportunity for construction services. The contractor certification form requests information on any OSHA violations incurred by the company within the last four years and the current insurance Experience Modification Rate, which must be supported by a signed letter from the contractor's insurance carrier.
The related federal contract opportunity is solicitation number 12805B22R0022 for construction of a wind break for Barn 6. The solicitation and all attachments are applicable. The contracting agency is the Agricultural Research Service Field Research Implementation and Information Delivery Plains Area within the Department of Agriculture.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment 5 Pre-Award Survey Form.doc | DOC document | |
| Attachment 6 SAM Reps and Certs Form.docx | DOCX document | |
| Attachment 1 Wage Determination TX20220255.pdf | ||
| Sol_12805B23R0022.pdf | ||
| Attachment 3 Design.pdf | ||
| Attachment 2 SOW.rtf | RTF text file |
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Contractor Certification Regarding Project: 12805B23R0022
| 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 .