ATTACHMENT F - EMR.pdf
PDF 145 KB Posted
- Solicitation number
- 36C24824R0186
About this file
This document is an EMR (Experience Modification Rate) form that is to be completed and submitted with a proposal for a federal contract opportunity. The EMR form requires the bidder/offeror to provide information on their company's OSHA 300 forms, including number of man-hours, number of cases involving days away from work, their DART (Days Away, Restricted, or Transferred) rate, and any OSHA violations within the last 3 years. The bidder/offeror must also provide their company's 6-digit NAICS code, who administers their safety and health program, and their EMR for the past 3 years.
The related federal contract opportunity is for Design-Build (D/B) services to expand the Sterile Processing Service (SPS) Maintenance Area at the Orlando VA Medical Center. The solicitation number is 36C24824R0186, the NAICS code is 236220 Commercial and Institutional Building Construction, and the magnitude of the project is between $250,000 and $500,000. The contract will be awarded using a two-phase design-build selection procedure, providing best value to the government.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24824R0186 0001.docx | DOCX document | |
| ATTACHMENT G - Experience Information Sheet.pdf | ||
| ATTACHMENT C - Site Plan.pdf | ||
| ATTACHMENT D - Wage Requirement.pdf | ||
| ATTACHMENT A - Specification 01 00 00 General Requirements.docx | DOCX document | |
| ATTACHMENT B - Floor Plan.pdf | ||
| ATTACHMENT E - Contract Progress Schedule.docx | DOCX document | |
| Solicitation 36C24824R0186.pdf | ||
| ATTACHMENT H - 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 2020 2021 2022 2023 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 .