Attachment 4 Contractor Certification Regarding EMR.pdf
PDF 162 KB Posted
- Attached to
- Critical Upgrades to Install a Floodgate at the Children's Nutrition Research Center, Houston, Texas
- Solicitation number
- 12805B24R0007
About this file
This document contains an attachment for a contractor certification and information on a related federal contract opportunity. The attachment requires contractors to provide the number of serious, willful, or repeat OSHA violations in the past four years along with an explanation for any violations. It also requires contractors to disclose their current insurance EMR rating and provide a signed letter from their insurance carrier to support it.
The related federal contract opportunity is solicitation number 12805B24R0007 to provide critical upgrades and install a floodgate at the Children's Nutrition Research Center in Houston, Texas. It is a 100% total small business set-aside with a NAICS code of 236220 and size standard of $45 million. The magnitude of the project is estimated between $500,000 and $1 million. Vendors must complete blocks 14, 15, 17 if applicable, 19 if any amendments are posted, and 20A-C in the solicitation form. Vendors must also be active in SAM.gov at the time of proposal submission according to FAR 52.204-7. The soliciting agency is the US Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery Plains Area.
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Text version
ATTACHMENT 4
Contractor Certification Regarding Project: 12805B24R0007
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 .