ATTACHMENT C - CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL.docx

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Attached to
Replace Flooring Throughout SMC 612A4-25-011
Solicitation number
36C26125R0067
Issued by

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The document is a Contractor Certification form related to a flooring replacement project for the Department of Veterans Affairs (VA) Veterans Health Administration, specifically for project 612A4-25-011. The certification requires contractors to disclose their safety record, including OSHA violations within the past 3 years, with strict disqualification criteria: four serious violations, one repeat violation, or one willful violation will eliminate a contractor from consideration. Additionally, contractors must provide their current Insurance Experience Modification Rate (EMR) supported by a signed letter from their insurance carrier. The solicitation (36C26125R0067) is exclusively for BIG MACC Contract Holders and involves replacing flooring throughout an SMC (likely a VA medical facility) during the 2020-2023 period.

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Other files

File Type Posted
NorCal Standard Flooring.pdf PDF
S06-36C26125R0067 0004.pdf PDF
Replace Flooring SMC Specs Version 2.pdf PDF
Mather Site Visit Log 7-11-25.pdf PDF
S06-36C26125R0067 0003.pdf PDF
MCC Site Visit Log 7-11-25.pdf PDF
Replace Flooring SMC Specs V2.pdf PDF
S06-36C26125R0067 0002.pdf PDF
S06-36C26125R0067 0001.pdf PDF
S02-36C26125R0067.pdf PDF
36C26125R0067.pdf PDF
ATTACHMENT 852.219-75 VA NOTICE OF LIMITATIONS.docx DOCX document
Copy of Exhibit A 6-18-25 V2.xlsx XLSX spreadsheet
ATTACHMENT REQUEST FOR INFORMATION FORM.pdf PDF
ATTACHMENT SITE VISIT LOG 36C26125R0067.pdf PDF
ATTACHMENT A - REPLACE FLOORING SMC SPECS.pdf PDF
Replace Flooring SMC Appendix A floorplan 6-18-25 V2.pdf PDF
ATTACHMENT B - PRICE BREAKDOWN.docx DOCX document
36C26125R0067.pdf PDF
ATTACHMENT WAGE DETRMINATION CA20250007 03212025.pdf PDF
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CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL

Contractor Certification Regarding Project: 612A4-25-011 Replace Flooring Throughout SMC

2020
2021
2022
2023

A number of serious, willful, or repeat violations from OSHA within the last 3 years. Please attach an explanation for any violations. (Four serious, one repeat, or one willful disqualifies the contractor.)

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:

Typed Name:

Title:

File details come from the government source that posted it. Updated .