Attachment 4 Contractor Certification Regarding EMR.pdf

This document is a contractor certification form for the Mechanical-Electrical-Plumbing (MEP) IDIQ solicitation issued by the Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery Plains Area. The form requires contractors to disclose the number of serious, willful, or repeat OSHA violations in the last four years and provide an explanation for any violations, as four serious, one repeat, or one willful violation could result in being deemed non-responsible. Contractors must also disclose their current insurance experience modification rate and provide a signed letter from their insurance carrier on letterhead supporting the disclosed rate. The certification must be signed and include the signer's name and title.