Attachment C_Contractor Certification RE Safety and EMR.docx
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- Solicitation number
- 36C26123R0107
About this file
This document contains a contractor certification regarding safety and environmental records for a federal construction project. The certification requires that to be eligible for consideration, contractors must have no more than three serious or one repeat or one willful OSHA or EPA violations within 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 from their insurance carrier of their current EMR. The related federal contract opportunity is for renovation work at a Department of Veterans Affairs facility involving re-roofing two buildings and renovating a food nutrition kitchen.
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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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