Attachment 4 - Contractor Certification Regarding EMR.pdf

173 KB Posted

Attached to
Edinburg, TX Fencing Project
Solicitation number
12805B23Q0937
Issued by

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This document contains an attachment for a federal contract solicitation. The attachment is a contractor certification form regarding occupational safety and health administration violations and the contractor's current insurance experience modification rate. Contractors must disclose any serious, willful, or repeat OSHA violations from the last four years and provide an explanation for any violations. Three serious, one repeat, or one willful violation will result in the contractor being deemed non-responsible. Contractors must also disclose their current insurance EMR and provide a signed letter from their insurance carrier on letterhead supporting the disclosed EMR.

The related federal contract opportunity is solicitation number 12805B23Q0937 for an Edinburg, TX fencing project from the Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery Plains Area.

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Attachment 8 - Back pen 2.PNG PNG image
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ATTACHMENT 4

Contractor Certification Regarding Project: 12805B23 937

201 20 202 202 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 .