ATTACHMENT D - EMR.pdf
PDF 102 KB Posted
- Solicitation number
- 36C24823R0014
About this file
This document contains a federal contract solicitation and a pre-award evaluation form for bidders.
The solicitation is seeking design-build services for deficiencies at the Address Lake Nona Central Energy Plant from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8. The project scope involves all labor, materials, tools and equipment for design and construction. The period of performance is 375 calendar days from notice to proceed. The place of performance is the Orlando VA Healthcare System campus. The estimated value is between $2,000,000 to $5,000,000. The NAICS code is 238220 and the product service code is Z2DZ. The solicitation process will use FAR Part 36.6 for the two-phase design-build selection and evaluate proposals based on best value. Bidders must be registered in SAM and VetBiz.
The attached pre-award evaluation form requests company information, OSHA recordable incident rates for the past four years, NAICS code, safety program administration details, and experience modification rates for the past three years. Submission of this completed form is required with proposals.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24823R0014 0001.docx | DOCX document | |
| PHASE ONE-RFI Tracking Log.pdf | ||
| ATTACHMENT F - Past Performance Questionnaire.docx | DOCX document | |
| ATTACHMENT C - LIMITATION ON SUBCONTRACTING CERTIFICATION.pdf | ||
| ATTACHMENT E - Experience Information Sheet.pdf | ||
| ATTACHMENT A - DBA WD FL20220218 07.22.2022.pdf | ||
| ATTACHMENT B - Contract Progress Schedule.docx | DOCX document | |
| 36C24823R0014.docx | DOCX document | |
| SOLICITATION 36C24823R0014.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 2018 2019 2020 2021 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): _____________ http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .