Attachment 4 - EMR Attachment.pdf
PDF 156 KB Posted
- Attached to
- Z1DA--Correct Interior Deficiencies 539-21-115 Federal contract opportunity
- Solicitation number
- 36C25021B0057
About this file
This solicitation package outlines requirements for a federal construction contract opportunity with the Department of Veterans Affairs. The project scope involves correcting interior deficiencies at the Cincinnati VAMC facility, with an estimated value between $1 million and $5 million. The NAICS code is 236220 for general building construction and the small business size standard is $39.5 million. This is a 100% set-aside for verified Service-Disabled Veteran-Owned Small Businesses. Offerors must be registered in both VetBiz.gov and SAM.gov. Prior to award, offerors must provide safety and environmental violation records demonstrating no more than three serious or one repeat/willful OSHA or EPA violations in the past three years, and an experience modification rate of 1.0 or less. The performance period is not to exceed 300 calendar days from notice to proceed. Payment and performance bonds will be required. The solicitation is expected to be posted on July 26, 2021 via SAM.gov.
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Text version
Pre-Award Contractor Safety and Environmental Record
Evaluation Form Information provided below is current and applicable to Solicitation # 36C25021B0057.
Company Name: ______________________________________________
Address: _____________________________________________________
Telephone: ______________________ Fax: ________________________
Email: _______________________________________________________
Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2018 2019 2020
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 .