ATTACHMENT D - EMR.pdf
PDF 778 KB Posted
- Solicitation number
- 36C24822R0041
About this file
This document contains a federal contract solicitation and an attachment for bidder evaluation. The solicitation is for design-build services to prepare the site for a replacement MRI at the Department of Veterans Affairs Viera Outpatient Clinic in Viera, Florida. The contract value is between $500,000 and $1,000,000 and has a period of performance of 210 calendar days from the notice to proceed. The NAICS code is 236220 for commercial and institutional building construction. The solicitation will use FAR Part 36 two-phase design-build procedures and FAR Part 15 for evaluation and award. The attachment is a pre-award evaluation form for bidders to submit with their proposals providing safety records, NAICS code, and insurance experience modification rates. Bidders must be registered in SAM and VetBiz and certified as a Service-Disabled Veteran-Owned Small Business to be considered for award.
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Other files
| File | Type | Posted |
|---|---|---|
| PHASE ONE - RFIs Tracking Log 11.24.2021.pdf | ||
| VIERA Asbestos Report 2016.pdf | ||
| 36C24822R0041 0001_1.docx | DOCX document | |
| ATTACHMENT C - Contract Progress Schedule.docx | DOCX document | |
| ATTACHMENT F - Past Performance Questionnaire.docx | DOCX document | |
| SOLICITATION 36C24822R0041.pdf | ||
| 36C24822R0041_1.docx | DOCX document | |
| ATTACHMENT B - DBA WD FL20210001 10.29.2021.pdf | ||
| ATTACHMENT E - Experience Information Sheet.pdf | ||
| ATTACHMENT A - Viera MRI Drawings.pdf |
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Text version
EMR FORM
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 2017 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): _____________
ATTACHMENT D {1 PAGE}
http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .