Attachment 8 Contractor Safety and Environmental Record Evaluation Form.docx
DOCX document 14 KB Posted
- Attached to
- Y1DA--Construct Dialysis and Sleep Program Construct and Renovate Chronic Dialysis & Sleep Program Project #612 502 Minor Construction - Martinez, CA VISN 21 Federal contract opportunity
- Solicitation number
- 36E77620R0039
About this file
This document contains a solicitation for construction services. The Department of Veterans Affairs is seeking bids for a construction project at the Martinez VA Outpatient Clinic in Martinez, California. The project involves constructing a 6,000 square foot addition to Building 20 for administration, dialysis, and sleep lab spaces. It also includes renovating 4,200 square feet of Building 20 for pharmacy, administration, canteen, and retail spaces. An additional 1,000 square foot addition to Building 19 is planned for a coffee shop. Dialysis boxes will also be installed in various patient rooms in an existing building. The solicitation will be issued as a request for proposal on July 24, 2020. The period of performance is approximately 760 calendar days from the notice to proceed. The estimated value of construction is over $10 million. The solicitation is set aside for Service-Disabled Veteran-Owned Small Businesses.
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36E77620R0039 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2016 |
| 2017 |
| 2018 |
| 2019 |
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.
File details come from the government source that posted it. Updated .