ATTACHMENT B - Criteria 2-Contractor Certification Safety and Environmental.docx

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Z1DA--Replace Research HVAC Systems | 662-21-105
Solicitation number
36C26121R0082
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This document contains criteria and certifications required for a contractor to bid on a replacement HVAC systems project for the Department of Veterans Affairs. The project will replace a chiller system and repair two air handling units at the VA San Francisco Health Care System campus.

To be eligible for consideration, contractors must have no more than three serious or one repeat or willful OSHA or EPA violations in the past three years, and a current Experience Modification Rate of 1.0 or less from their insurance carrier. Bidders must submit a letter certifying their safety and environmental record for the past three years, and a signed letter from their insurance carrier with their current EMR. The solicitation number for the project is 36C26121R0082, with an estimated cost between $100,000 and $250,000. The project will be a total set-aside for Service-Disabled Veteran Owned Small Businesses. The solicitation documents will be available on July 25, 2021, with any questions to be sent in writing to the point of contact provided.

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ATTACHMENT B – 36C26121R0082

CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL

Contractor Certification Regarding Project: 662-21-105 Titled Replace Research HVAC Systems PER VHA DIRECTIVE 7715 (06 April 2017): SAFETY & ENVIRONMENTAL RECORD AND EXPERIENCE MODIFICATION RATE (EMR): To be eligible for consideration and award, the contractor shall have no more than three serious, or one repeat, or one willful OSHA or EPA violation(s) in the past 3 years and have an EMR of equal to or less than 1.0.

All Bidders shall submit the following information pertaining to their past Safety & Environmental Record and EMR with their bid/proposal:

SAFETY & ENVIRONMENTAL RECORD: A self-certification on company letterhead that the bidder has no more than three (3) serious, or one (1) repeat or one (1) willful OSHA or any EPA violation(s) in the past three years. Include the following table and signature block.

2018
2019
2020

Number of serious, willful, or repeat violations from OSHA within the last 3 years.

Number of EPA violations within the last 3 years

Signature: ______________________________________________ Typed Name: ______________________________________________________ Title: ______________________________________________________

EMR: All bidders shall submit information regarding their current EMR. This information shall be obtained from the bidder’s insurance carrier and be furnished on the insurance carrier’s letterhead.

Company’s Current Insurance Experience Modification Rate (EMR) = _____________ (Note: Contractor must support the EMR with a signed letter from Insurance Carrier on their letterhead.)

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