Attachment C_Contractor Certification RE Safety and EMR.docx
DOCX document 15 KB Posted
- Attached to
- Z1DA--NRM 654-23-001 | Reroof Bldgs 1D and 10
- Solicitation number
- 36C26123R0113
About this file
This document contains a contractor certification regarding safety and environmental records for a federal contract opportunity to replace and re-roof buildings 1D and 10 at a VA facility. 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 an experience modification rate of 1.0 or less. Offerors must submit a self-certification on company letterhead regarding their violation history over the past three years, as well as documentation of their current EMR directly from their insurance carrier on the carrier's letterhead. The related federal contract opportunity is solicitation number 36C26123R0113 to reroof buildings 1D and 10, issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21.
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Other files
| File | Type | Posted |
|---|---|---|
| RFIs response 1D and 10 Roof.pdf | ||
| Attachment 5 WD NV20230040 09152023.pdf | ||
| Attachment 6 Sign-in sheet 1011.pdf | ||
| 18-078 SubReg 100_.pdf | ||
| 36C26123R0113 0002.docx | DOCX document | |
| 2010 Asbestos Report-Building 1D.pdf | ||
| ASBESTOS DRAWINGS - 30x42.pdf | ||
| 36C26123R0113 0001.docx | DOCX document | |
| RENO PLAN SET - RECORD.pdf | ||
| Att B Price Breakdown.pdf | ||
| 36C26123R0113_1.docx | DOCX document | |
| Wage Determination NV20230026 08182023.pdf | ||
| Combined Specs.pdf | ||
| Combined Drawings.pdf |
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Text version
ATTACHMENT C
CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL
Contractor Certification Regarding Project: 654-23-001 36C26123R0101 - VA Reno – Replace and Re-roof Buildings 1D and 10 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) within 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 bid/proposal:
SAFETY & ENVIRONMENTAL RECORD: A self-certification on company letterhead that the Offeror has no more than three (3) serious, or one (1) repeat or one (1) willful OSHA or any EPA violation(s) within the past three years. Include the following table and signature block.
| 2020 |
| 2021 |
| 2022 |
Number of serious, willful, or repeat violations from OSHA within the last 3 years.
Number of serious, willful, or repeat violations from EPA within the last 3 years
Signature: ______________________________________________ Typed Name: ______________________________________________________ Title: ______________________________________________________
EMR: All Offerors shall submit information regarding their current EMR. This information shall be obtained from the Offeror’s insurance carrier and be furnished on the insurance carrier’s letterhead.
Contractor’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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