Attachment 4 Contractor Certification Regarding EMR.pdf
PDF 134 KB Posted
- Attached to
- Construct Wildlife Barn Federal contract opportunity
- Solicitation number
- 12805B23R0023
About this file
This document is an attachment to a solicitation for the construction of a wildlife barn. The attachment requires contractors to disclose the number of serious, willful, or repeat violations from OSHA in the last four years and provide explanations for any violations. It also requires contractors to disclose their current insurance experience modification rate and provide supporting documentation from their insurance carrier.
The related federal contract opportunity is solicitation number 12805B23R0023 from the Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery Plains Area to construct a wildlife barn. The solicitation requires disclosure of safety violations and insurance rates as detailed in the attachment.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Questions from Industry -18 July 2023.pdf | ||
| Geotechnical Engineering Report CFTRL.pdf | ||
| 12805B23R0023 Through Amend 2.pdf | ||
| Attachment 1 Wildlife Barn Drawings.pdf | ||
| Attachment 2 Wildlife Barn Specifications.pdf | ||
| 12805B23R0023 Amend 0002.pdf | ||
| Site Visit Attendance.pdf | ||
| 12805B23R0023 Through Amend 1.pdf | ||
| 12805B23R0023 Amend 0001.pdf | ||
| 12805B23R0023.pdf | ||
| Exhibit A - Bid Schedule - 12805B23R0023.xlsx | XLSX spreadsheet | |
| Attachment 1 Wildlife Barn Drawings.pdf | ||
| Attachment 2 Wildlife Barn Specifications.pdf | ||
| Attachment 3 Fencing Material Specifications.docx | DOCX document | |
| Attachment 6 ARS-371 Construction Progress and Payment Schedule.pdf | ||
| Attachment 8 Template C Contractors Release of Claims.pdf | ||
| Attachment 5 WD TX20230255 Mod 0 Dated 6 Jan 2023.pdf | ||
| Attachment 7 ARS-372 Request for Payment.pdf |
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Text version
ATTACHMENT 4
Contractor Certification Regarding Project: 12805B23R0023
2020 2021 2022 2023 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 .