Attachment 6 -(Exhibit C) EMR.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C24822R0136
About this file
This document contains a pre-award contractor evaluation form and details of a related federal contract opportunity. The form requests information on a bidding contractor's OSHA 300 forms from 2018-2020 including man hours, cases involving days away from work or restricted activity, and DART rate. It also asks for the contractor's NAICS code, who administers its safety program, and insurance EMR rates for the past three years.
The related federal contract opportunity is to provide all necessary equipment, labor, materials, and services to complete physical security deficiencies corrections at the Lee County Health Care Center VA Clinic in Cape Coral, Florida within 232 calendar days. Work includes hardening site utility entrances, vehicle gates, perimeter fence, and mailroom compliance. The solicitation number is 36C24822R0136 from the Department of Veterans Affairs Veterans Health Administration VISN 8.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24822R0136 Correct LCHCC Physical Security Def RFIs.xlsx | XLSX spreadsheet | |
| 36C24822R0136 0007.pdf | ||
| July 21 site visit sign in sheet.pdf | ||
| 36C24822R0136 0006.pdf | ||
| 36C24822R0136 0005.pdf | ||
| 36C24822R0136 0004.pdf | ||
| 36C24822R0136 0003.pdf | ||
| 516-19-125 LEE COUNTY100CD 20210409.pdf | ||
| 36C24822R0136 0002.pdf | ||
| 36C24822R0136 0001.pdf | ||
| site plan with scope areas.pdf | ||
| site plan 1.pdf | ||
| site plan 2.pdf | ||
| 36C24822R0136_1.pdf | ||
| Attachment 8 (Exhibit B) Past and Present Performance Questionnaire.docx | DOCX document | |
| 516-19-125 Lee County Specifications.pdf | ||
| Copy of Attachment 4 - Price Matrix.xlsx | XLSX spreadsheet | |
| 36C24822R0136_1.pdf | ||
| Attachment 7- (Exhibit A) Performance Relevancy Survey v2.docx | DOCX document | |
| Lee County Wage Determination 2022.pdf | ||
| 516-19-125 LEE COUNTY100CD 20210409 drawings.pdf | ||
| Copy of attachment 9 - q_a rfis.xlsx | XLSX spreadsheet |
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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 .