Attachment 4 Contractor Certification Regarding EMR.pdf
PDF 134 KB Posted
- Attached to
- Construct Wildlife Barn
- 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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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 .