Attachment 4 Contractor Certification Regarding EMR.pdf
PDF 134 KB Posted
- Attached to
- Construct Underground Duct Bank Federal contract opportunity
- Solicitation number
- 12805B23R0018
About this file
This document contains an attachment regarding contractor certification for a federal solicitation to construct an underground duct bank. The solicitation requests information on any OSHA violations in the past four years and the bidder's current insurance experience modification rate. Bidders must provide explanations for any serious, willful, or repeat OSHA violations and support their experience modification rate with a signed letter from their insurance carrier. The solicitation also provides details on the statement of work, which involves constructing a new electrical service and switching power from a new duct bank to an agricultural research facility building. Questions regarding the solicitation must be submitted in writing by April 27, 2023, with responses posted on SAM.gov. The contracting 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 |
|---|---|---|
| Questions from Industry - REV 1 - Final_Response.pdf | ||
| Questions from Industry - Final_Response.pdf | ||
| Addendum 1 Electrical.pdf | ||
| 12805B23R0018 Amend 0002.pdf | ||
| 12805B23R0018 Amend 0001.pdf | ||
| 12805B23R0018.pdf | ||
| Attachment 5 ARS-371 Construction Progress and Payment Schedule.pdf | ||
| Attachment 7 Template C Contractors Release of Claims.pdf | ||
| Attachment 1 Statement of Work.pdf | ||
| Attachment 2 Specification Booklet.pdf | ||
| Attachment 6 ARS-372 Request for Payment.pdf | ||
| Exhibit A - Bid Schedule.xlsx | XLSX spreadsheet | |
| Attachment 3 WD OK20230068 Mod 2 Effective 10 Feb 2023.pdf |
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Text version
ATTACHMENT 4
Contractor Certification Regarding Project: 12805B23R0018
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 .