ATTACHMENT D - EMR.pdf
PDF 778 KB Posted
- Solicitation number
- 36C24821R0191
About this file
This document contains a federal solicitation for design-build services for a Department of Veterans Affairs project. The solicitation is seeking proposals for Phase I only, to determine which offerors will be selected to submit Phase II proposals for design and construction services for the Lake Baldwin MRI Replacement Site Prep project at the Lake Baldwin Outpatient Clinic in Orlando, Florida. The project amount is between $500,000 and $1,000,000, the NAICS code is 236220 for commercial and institutional building construction, and the solicitation will utilize a two-phase design-build source selection process and FAR Part 15 for evaluation and award. Proposals are due by August 15, 2022 and must come from verified Service-Disabled Veteran-Owned Small Businesses. The period of performance is 270 calendar days from notice to proceed.
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Other files
| File | Type | Posted |
|---|---|---|
| Bldg 500 Low Bay AHUs.pdf | ||
| PHASE ONE-RFIs Tracking Log 11.24.2021.pdf | ||
| Lake Baldwin Asbestos Survey Bldg 500 pictures only.pdf | ||
| 36C24821R0191 0002.docx | DOCX document | |
| Lake Baldwin Asbestos Survey Bldg 500.pdf | ||
| AMENDMENT 36C24821R0191 0001.docx | DOCX document | |
| ATTACHMENT C - Contract Progress Schedule.docx | DOCX document | |
| 36C24821R0191_1.docx | DOCX document | |
| SOLICITATION 36C24821R0191.pdf | ||
| ATTACHMENT B - DBA WD FL20210218 10.01.2021.pdf | ||
| ATTACHMENT A - Lake Baldwin MRI Site Reference Drawings.pdf | ||
| ATTACHMENT E - Experience Information Sheet.pdf | ||
| ATTACHMENT F - Past Performance Questionnaire.docx | DOCX document |
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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 .