Attachment 4 Contractor Certification Regarding EMR.docx

DOCX document 14 KB Posted

Attached to
Replace Fire Alarm Bldg 22 and 24 Federal contract opportunity
Solicitation number
12805B22R0005
Issued by
Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery Plains Area

About this file

This document contains an attachment regarding contractor certification and a related federal contract opportunity notice. The attachment requests information on any OSHA violations from the past four years and the contractor's current insurance EMR rating, to be supported by a signed letter from the carrier.

The related federal contract opportunity is a solicitation to replace fire alarms at buildings 22 and 24 of the USDA Agricultural Research Service facility in Lubbock, Texas. Interested contractors must register by March 7th to attend an optional site visit on March 9th at 9:00am CST. The agency listed is the USDA Agricultural Research Service Plains Area Field Research Implementation and Information Delivery office.

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Text version

Contractor Certification Regarding Project: 12805B22R0005

2018
2019
2020
2021

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 .