ATTACHMENT F - EMR FORM.pdf
PDF 265 KB Posted
- Solicitation number
- 36C24822R0147
About this file
This document includes a solicitation for design-build services to replace a hybrid operating room at a Miami VA medical center. The Department of Veterans Affairs seeks proposals to provide all design and construction services for the project with a period of performance of 310 calendar days from notice to proceed. Offerors must be verified Service-Disabled Veteran-Owned Small Businesses. The project budget is between $500,000 and $1,000,000 according to the Federal Acquisition Regulation. The associated North American Industry Classification System code is 236220 for commercial and institutional building construction. The solicitation process will follow FAR Parts 15 and 36.6 to evaluate proposals and award a firm fixed-price contract. Interested firms must register in the System for Award Management and VetBiz databases to be considered. Contractors will be expected to comply with environmental laws and policies.
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT E - CONTRACT PROGRESS SCHEDULE.docx | DOCX document | |
| SOLICITATION 36C24822R0147.pdf | ||
| 36C24822R0147_1.docx | DOCX document | |
| ATTACHMENT C - DBA WD FL20220215 07.01.2022.pdf | ||
| ATTACHMENT H - PAST PERFORMANCE QUESTIONNAIRE.docx | DOCX document | |
| ATTACHMENT B - OR8 FLOOR PLAN - DRAWINGS.pdf | ||
| ATTACHMENT G - EXPERIENCE INFORMATION SHEET.pdf | ||
| ATTACHMENT D - LIMITATION ON SUBCONTRACTING CERTIFICATION.docx | DOCX document | |
| ATTACHMENT A - 01 00 00 General Conditions.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 20 1 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 F - EMR FORM
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