Attachment D - EMR (1 Page).docx

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Y1DA--D/B Renovate Mammography Room for Medical Equipment
Solicitation number
36C24822R0036
Issued by

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This document contains a federal contract opportunity solicitation for design-build renovation services. The Department of Veterans Affairs Network Contracting Office in Miami, Florida is seeking proposals to design and construct a full renovation of the mammography room at the Lake Baldwin campus of the Orlando VA Medical Center. The renovation scope includes all labor, materials, and services necessary to install a new mammography machine in approximately 160 square feet of clinical space within the radiology service area. The estimated value of the construction is between $100,000 and $250,000. The solicitation is set aside exclusively for service-disabled veteran-owned small businesses and will be issued on the SAM.gov website around November 29, 2021 with a proposed closing date of December 29, 2021 for responses. Interested firms must be registered in the System for Award Management.

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Other files

File Type Posted
Solicitation Amendment 36C24822R0036 0001- DB Renovate Mammography Room at Lake Baldwin.pdf PDF
Attachment G - Solicitation 36C24822R0036 - DB Renovate Mammography Room at Lake Baldwin -Revised 12-02-21.pdf PDF
Attachment A - Itemized Schedule of Values Cost Breakdown.xlsx XLSX spreadsheet
Attachment B - Mammography Room 1087 - Lake baldwin.pdf PDF
Solicitation 36C24822R0036 - DB Renovate Mammography Room at Lake Baldwin.pdf PDF
Attachment E - Specialized Experience Form (3 Pages).pdf PDF
Attachment C - Wage Determination - General Decision Number FL20210215 - 10-01-2021.pdf PDF
Attachment F - Past Performance Questionnaire.pdf PDF

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EMR FORM FOR BIDDER/OFFEROR TO COMPLETE & SUBMIT WITH PROPOSAL

Pre-Award Contractor Evaluation Form Company Name: ______________________________________________

Address: _____________________________________________________

Telephone: ______________________ Fax: ________________________

Email: _______________________________________________________

Contact: ______________________________________________________

1. Utilizing your OSHA 300 Forms, please complete the following information:

Category
2018
2019
2020

Number of man hours (jobsite and office)

Number of cases involving days away from work, restricted activity, or both (Column H and I of OSHA 300).

Days away, restricted, or transferred rate (# of days away, restricted, or transferred cases x 200,000/# of man hours) (DART Rate).

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.)

Please attach copies of the following documents: OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page: http://www.osha.gov/pls/publications/publication.html.

2. Provide your six-digit North American Industrial Classification System (NAICS) Code for this acquisition: __________________________________

3. Who administers your company’s Safety and Health Program? __________________________________

4. Company’s Insurance Experience Modification Rate (EMR) for the past 3 years (an EMR of greater than 1.0 disqualifies the contractor): _____________

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