Attachment 4 - EMR.docx
DOCX document 16 KB Posted
- Attached to
- Replace Electrical Panel Board in OR Federal contract opportunity
- Solicitation number
- 36C248
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| S02 - Attach 10 Set of Drawings 3 of 4.pdf | ||
| S02 - Attach 9 Set of Drawings 2 of 4.pdf | ||
| S02 - Attach 8 Set of Drawings 1 of 4.pdf | ||
| S02 - Attach 7 Price Matrix.xlsx | XLSX spreadsheet | |
| S02 - Attach 14 Narrative Set 3 of 3.pdf | ||
| S02 - Attach 5 Past Performance Form.pdf | ||
| S02 - Attach 3 Limitations of Subcontracting .pdf | ||
| S02 - Attach 2 _ Wage Dtermination FL20220125 _9_29_22.pdf | ||
| S02 - Attach 15 Floor Plan.pdf | ||
| S02 - Attach 12 Narrative Set 1 of 3.pdf | ||
| S02 - Attach 11 Set of Drawings 4 of 4.pdf | ||
| S02 - Attach 13 Narrative Set 2 of 3.pdf | ||
| S02 - Attach 6 Experience Information Sheet.docx | DOCX document | |
| Attachment 1 - Site Plan.pdf | ||
| S02 - SOLICITATION 36C24823R0003_10_11_22.pdf |
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Text version
EMR FORM FOR BIDDER/OFFEROR TO COMPLETE & SUBMIT WITH PROPOSAL Attach 4 Pre-Award Contractor Evaluation Form Company Name: ______________________________________________
Address: _____________________________________________________
Telephone: ______________________ Fax: ________________________
Email: _______________________________________________________
Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2019 |
| 2020 |
| 2021 |
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. (Four serious, one repeat, or one willful disqualifies the contractor.)
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 your 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) for the past 3 years (an EMR of greater than 1.0 disqualifies the contractor): _____________
File details come from the government source that posted it. Updated .