Attachment 4 Contractor Certification Regarding EMR.docx
DOCX document 14 KB Posted
- Attached to
- Wood Flooring Replacement Federal contract opportunity
- Solicitation number
- 12805B23R0030
About this file
This document is an attachment to a federal solicitation for wood flooring replacement services. The solicitation is issued by the Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery Plains Area. The attachment requires contractors to disclose any serious, willful, or repeat violations from OSHA in the last four years and provide an explanation for any violations. It also requires contractors to disclose their current insurance experience modification rate and provide a signed letter from their insurance carrier on letterhead supporting the provided rate. Contractors must sign and include their name and title with the attachment.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment 5 Pre-Award Survey Form.doc | DOC document | |
| Attachment 1 Wage Determination KS20230056.pdf | ||
| Attachment 2 SOW.docx | DOCX document | |
| Attachment 3 Specs and Drawings.pdf | ||
| Sol_12805B23R0030.pdf | ||
| Attachment 6 SAM Reps and Certs Form.docx | DOCX document |
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Text version
Contractor Certification Regarding Project: 12805B23R0030
| 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 .