Attachment 6 Contractor Safety and Environmental Record Evaluation Form.docx
DOCX document 17 KB Posted
- Solicitation number
- 36C24924B0009
About this file
This statement of work outlines requirements for an energy management system and building automation system upgrade project at the Tennessee Valley Healthcare System Alvin C. York Campus. The scope of work includes replacing existing control panels and components with native BACnet systems, installing a new fiber optic network, upgrading direct digital controls to function as an integrated system, and providing programming, cabling, and commissioning services. Key deliverables and requirements are the installation of control panels and devices, fiber optic switches and cabling, graphics development, programming and configuration of the new system, training, and a one year warranty. The contractor must complete all work within 365 calendar days of the notice to proceed. The bid includes a base item for all work and an alternate deduct for excluding certain future panels, fiber, and cabling.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24924B0009 0004.pdf | ||
| 36C24924B0009 0003.pdf | ||
| 36C24924B0009 0002.pdf | ||
| 36C24924B0009 0001.pdf | ||
| Attachment 12 WD Rutherford County Building TN20230187 dated 01052024.pdf | ||
| 36C24924B0009_1.docx | DOCX document | |
| Attachment 8 Price Breakout Schedule.xlsx | XLSX spreadsheet | |
| Attachment 5 Drawings Bldg 15-120 and Fisher House.pdf | ||
| Attachment 2 Bid Item Panel Upgrade List.xlsx | XLSX spreadsheet | |
| Attachment 1 Panel Upgrade List.xlsx | XLSX spreadsheet | |
| Attachment 3 Specification 2020-10-02 FINAL.pdf | ||
| Attachment 4 Drawings Cover Page Site Controls Bldg 1-11.pdf | ||
| Attachment 7 Calculation of Contractor Self Performed Work.xlsx | XLSX spreadsheet | |
| Attachment 11 RFI Form.docx | DOCX document | |
| Attachment 10 TAX ID UEI Document.docx | DOCX document | |
| Attachment 9 General Conditions Breakout.xlsx | XLSX spreadsheet |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Solicitation 36C24924B0009
Company Name:
Address:
Telephone:
Email:
Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2021 |
| 2022 |
| 2023 |
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.
1. Provide six-digit North American Industrial Classification System (NAICS) Code for this acquisition: 238210 – Electrical Contractors and Other Wiring Installation Contractors
1. Who administers your company’s Safety and Health Program?
1. Company’s Insurance Experience Modification Rate (EMR):
End of Safety and Environmental Record Evaluation Form
File details come from the government source that posted it. Updated .