Attachment 4 Contractor Certification Regarding EMR.pdf

191 KB Posted

Attached to
Mechanical-Electrical-Plumbing (MEP) IDIQ - Plains Area - North
Solicitation number
12805B20R0010
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Contractor Certification Regarding Project: Plains Area MEP 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:

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