Attachment 9 - EMR.docx
DOCX document 22 KB Posted
- Solicitation number
- 36C24821R0141
About this file
This document contains a pre-award contractor evaluation form and information about a related federal contract opportunity for renovating and expanding a hemodialysis suite.
The pre-award contractor evaluation form requests safety information from bidders, including OSHA 300 and 300A forms from 2017 to 2020, NAICS code, safety program administrator, and experience modification rates for the past three years. The related federal contract opportunity is set aside for Service-Disabled Veteran-Owned Small Businesses to provide construction services expanding and renovating the hemodialysis suite at the Bruce W. Carter VA Healthcare Center in Miami, Florida. Work includes demolition, new equipment installation, and systems for air conditioning, plumbing, and lighting. The solicitation will be issued on or around July 21, 2021 via beta.SAM.gov and responses are due June 21, 2021. The magnitude of construction is estimated between $1-5 million. The Department of Veterans Affairs Veterans Health Administration VISN 8 is the agency for this requirement located in Miami, Florida.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24821R0141 0002.pdf | ||
| Site Visit Page 2.docx | DOCX document | |
| Site Visit Page 1.docx | DOCX document | |
| 36C24821R0141 0001.pdf | ||
| RFIs Log Hemodialysis.pdf | ||
| Solicitation for 36C24821R0141.pdf | ||
| Attachment 8 - Past Performance Questionnaire.pdf | ||
| Attachment 5 - Wage Determination.pdf | ||
| Attachment 3 - Specifications Volume 2B.pdf | ||
| Attachment 1 - Specifications Volume 1.pdf | ||
| Attachment 4 - Drawings Complete Set.pdf | ||
| Attachment 6 - LOS Certification.doc | DOC document | |
| Attachment 7 - Price Matrix.xlsx | XLSX spreadsheet | |
| Attachment - 10 - Experience Information Sheet.docx | DOCX document | |
| Attachment 2 - Specifications Volume 2A.pdf |
Show all 15
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Text version
36C24821R0141
EMR FORM
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 |
| 2017 |
| 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 .