Attachment 5 Experience Modification Rate EMR Insurance Contractor Certification.docx

DOCX document 14 KB Posted

Attached to
Amendment 0001/Separate Discharge at SNFRU Greenhouse Facility #4 Federal contract opportunity
Solicitation number
12405B22Q0141
Issued by
Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery

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Other files for this federal contract opportunity

Other files attached to Amendment 0001/Separate Discharge at SNFRU Greenhouse Facility #4, newest first.
File Type Posted
QUESTIONS RECEIVED Solicitation 12405B22Q0141 Separate Discharges.docx DOCX document
SF 30 AMENDMENT 0001 SOLICITATION 12405B22Q0141.pdf PDF
Attachement 4 Wage Grade Determination DBA SC20220040.pdf PDF
Attachment 1 SOLICITATION 12405B22Q0141.pdf PDF
Attachment 2 Specifications Solicitation 12405B22Q0141.pdf PDF
Attachment 3 Drawings Solicitation 12405B22Q0141.pdf PDF
Attachment 6 Pre-Award Survey Form.doc DOC document

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Contractor Certification Regarding Project: 12405B22Q0141

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 .