Attachment B - EMR Sheet.docx
DOCX document 19 KB Posted
- Attached to
- Z1DA-- Renovate OR for Hybrid Installation
- Solicitation number
- 36C26126R0009
About this file
This document is an Attachment B safety and environmental record certification sheet for Solicitation 36C26126R0009, a VA project to renovate an Operating Room (OR) for Hybrid Installation at the VA Northern California Health System in Mather, CA. The attachment outlines strict safety qualification requirements for potential contractors, mandating that bidders have no more than three serious, or one repeat, or one willful OSHA or EPA violations in the past three years, and an Experience Modification Rate (EMR) of 1.0 or less.
Contractors must submit a self-certification on company letterhead verifying their safety record and provide documentation from their insurance carrier confirming their current EMR. The solicitation includes a site visit scheduled for Thursday, December 11, 2025, at 10:00 AM Pacific Time, located in front of Building 650 at 10535 Hospital Way, Mather, CA. The project is being managed by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21.
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Text version
36C26126R0009 PER VHA DIRECTIVE 7715 (06 April 2017) - SAFETY & ENVIRONMENTAL RECORD AND EXPERIENCE MODIFICATION RATE (EMR):
Contractor Certification Regarding Project:
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 Offerors shall submit the following information pertaining to their past Safety & Environmental Record and EMR with their offer.
1. SAFETY & ENVIRONMENTAL RECORD: A self-certification on company letterhead that the contractor 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.
2. EMR: All Offerors shall submit information regarding their current EMR. This information shall be obtained from the Offerors’s insurance carrier and be furnished on the insurance carrier’s letterhead. If an Offeror’s EMR is above 1.0, Offeror shall submit a written explanation of the EMR from its insurance carrier furnished on the insurance carrier’s letterhead, describing the reasons for the EMR, and the anticipated date the EMR may be reduced to 1.0 or below.
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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.)
Number of violations from EPA within the last 3 years. Please attach explanation for any violations.
Company’s Current Insurance Experience Modification Rate (EMR) = (Note: Contractor must support the EMR with a signed letter from Insurance Carrier on their letterhead.)
Signature:
Print Name:
File details come from the government source that posted it. Updated .