Attachment 4 - EMR Attachment.pdf
PDF 111 KB Posted
- Solicitation number
- 36C25021B0012
About this file
This document contains a pre-award contractor safety evaluation form and details of a federal contract solicitation for repair and construction work. The pre-award form requests safety-related information from bidders, including OSHA recordkeeping data from 2017 to 2019, NAICS code, safety program administration, and experience modification rate.
The solicitation is for repair of exterior walls and window replacement at a Department of Veterans Affairs medical center. The estimated value is between $5 million and $10 million. Work includes general construction, alterations, and necessary removals to complete the project. The IFB is expected to post on January 14, 2021, with bids due within 30-45 days. The contractor will have 550 days from notice to proceed to fully complete the work. Plans will be available with the IFB. Requests for the IFB should be submitted before January 14, 2021 at 1:00 PM EST. This opportunity is set aside for service-disabled veteran-owned small businesses.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25021B0012 0008.docx | DOCX document | |
| Addendum 08-04.14.21.pdf | ||
| 36C25021B0012 0007.docx | DOCX document | |
| Addendum 06-04.05.21.pdf | ||
| 36C25021B0012 0006.pdf | ||
| Attachment 3 -Contractor EMR Certification Form.pdf | ||
| Addendum 05-03.24.21.pdf | ||
| 36C25021B0012 0005.docx | DOCX document | |
| 36C25021B0012 0004.docx | DOCX document | |
| 36C25021B0012 0003.docx | DOCX document | |
| Site VIsit Sign-in.pdf | ||
| 36C25021B0012 0002.docx | DOCX document | |
| 36C25021B0012 0001.docx | DOCX document | |
| Attachment 2-Drawings.pdf | ||
| Attachment 5-DBA-WD-OH020210082.pdf | ||
| Attachment 1-Specifications.pdf | ||
| 36C25021B0012_1.docx | DOCX document | |
| Attachment 3 - RFI Form.pdf |
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Text version
Pre-Award Contractor Safety and Environmental Record
Evaluation Form Information provided below is current and applicable to Solicitation # 36C25020B0064.
Company Name: ______________________________________________
Address: _____________________________________________________
Telephone: ______________________ Fax: ________________________
Email: _______________________________________________________
Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2017 2018 2019
Number of man hours (jobsite and office).
Number of cases involving days away from work, restricted activity, or both (Column H and I of OSHA 300).
Days away, restricted, or transferred rate (# of days away, restricted, or transferred cases x 200,000/# of man hours)
(DART Rate).
Number of serious, willful, or repeat violations from OSHA within the last 3 years. Please attach explanation for any violations.
Please attach copies of the following documents: OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page:
http://www.osha.gov/pls/publications/publication.html.
2. Provide six-digit North American Industrial Classification System (NAICS) Code for this acquisition: __________________________________
3. Who administers your company’s Safety and Health Program?
4. Company’s Insurance Experience Modification Rate (EMR):
http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .