Attachment B - EMR Sheet.docx
DOCX document 19 KB Posted
- Solicitation number
- 36C26126R0028
About this file
This file is an Equipment and Material (EMR) sheet attachment related to a construction services solicitation for the Department of Veterans Affairs Palo Alto Health Care System. The document serves as a template or appendix that does not specifically address required products or services in substantive detail. As an attachment to the broader solicitation for renovation and expansion of the Sterile Processing Department (SPD) and Supply Chain Services (SCS) at the Palo Alto Division facility, this EMR sheet would typically be used to document equipment and material requirements, specifications, or cost breakdowns necessary for contractors to understand project scope and prepare accurate bids. However, without the substantive content of the sheet itself visible in this reference, the specific equipment, materials, quantities, or cost information required for the project cannot be detailed in this summary.
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Text version
36C26126R0028 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.
| 2023 |
| 2024 |
| 2025 |
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 .