Attachment 6 -(Exhibit C) EMR.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C24821R0139
About this file
This document contains a pre-solicitation announcement and Exhibit C form for a construction project opportunity with the Department of Veterans Affairs. The project involves expanding and renovating the Cardiothoracic Intensive Care Unit located at the Malcolm Randall VA Medical Center in Gainesville, Florida to increase capacity, eliminate deficiencies, and improve functionality, patient access, and privacy. The scope of work includes HVAC upgrades and corrections for code deficiencies. Bid alternates will deduct switchable privacy glass and replace with ceiling curtains or clear glass. The estimated construction period is 365 days with a firm fixed price contract to be awarded within 120 days of bid receipt. The estimated value is between $1 million and $5 million. The NAICS code is 236220. Offerors must register in SAM and on the VetBiz registry. Questions may be submitted by email to the point of contact by the response due date specified in the forthcoming solicitation.
The Exhibit C form requests safety data from offerors including OSHA recordable incidents, rates, violations, and insurance experience modification rates for evaluation. Offerors must submit this completed form with their proposal along with supporting documentation.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 3 - LOS Certification Solicitation Version.doc | DOC document | |
| Attachment 9 - Q_A RFIs.xlsx | XLSX spreadsheet | |
| Attachment 5- DB Wage Rates FL20210194 05.07.2021.pdf | ||
| Attachment 4 - Price Matrix.xlsx | XLSX spreadsheet | |
| 36C24821R0139.docx | DOCX document | |
| Attachment 8 (Exhibit B) Past and Present Performance Questionnaire.docx | DOCX document | |
| Attachment 1- Specifications.zip | ZIP file | |
| Attachment 7- (Exhibit A) Performance Relevancy Survey v2.docx | DOCX document | |
| 36C24821R0139_3.docx | DOCX document | |
| Attachment 2- Drawings.zip | ZIP file |
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Text version
EMR FORM FOR BIDDER/OFFEROR TO COMPLETE & SUBMIT WITH PROPOSAL
Pre-Award Contractor Evaluation Form 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. (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 .