Attachment D - EMR.docx

DOCX document 14 KB Posted

Attached to
Z2NE-- FY22: NRM PLUS UP; (PROJ: 546-19-102) BB Upgrade Water Mains Building 1
Solicitation number
36C24822R0026
Issued by

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This document contains a pre-award contractor evaluation form and details of a related federal contract opportunity. The pre-award form requests safety and health information from bidders, including OSHA recordable incident rates for the past three years, NAICS code, and experience modification rates. The related federal opportunity is seeking construction services to replace and upgrade water mains at the Miami VA Healthcare System. Interested parties must be Service-Disabled Veteran Owned Small Businesses. Price proposals are due on January 6, 2022. The work includes replacing transite piping, which requires special handling and disposal. The Department of Veterans Affairs Network Contracting Office 8 will award a fixed-price contract for the project, scheduled to upgrade water mains in Building 1 and analyze isolation valve needs.

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Other files

File Type Posted
Attachment E - Past Performance Questionnaire.pdf PDF
Attachment C - Price Matrix.xlsx XLSX spreadsheet
Attachment H - Bid Docs Pages 1 - 30 Plumbing (1).pdf PDF
Attachment A - Wage Determination.pdf PDF
Attachment K- Bid Docs Drawings Pages 11 - 21.pdf PDF
Attachment M - Bid Docs PAGES 31 - 38.pdf PDF
Attachment J - Bid Docs Drawings Pages 1 - 10.pdf PDF
Attachment G - Bid Documents Specifications 546-19-109.pdf PDF
Attachment I - Bid Docs Pages 31 - 68 Plumbing.pdf PDF
Attachment L - Bid Docs Pages 22 - 30.pdf PDF
36C24822R0026 Solicitation.pdf PDF
Attachment F - Bid Documents Submittal 546-19-102.pdf PDF
Attachment B - Specialized Experience Form (3 Pages).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 .