Attachment II - EMR.pdf
PDF 139 KB Posted
- Attached to
- Z1DA--Update Elevators 610A4-24-507
- Solicitation number
- 36C25024B0015
About this file
This document contains a pre-award contractor safety evaluation form and details of a related federal contract opportunity for elevator updates. The pre-award form requests safety-related information from contractors such as OSHA recordable incident rates, violations, and insurance experience modification rates. Bidders are asked to provide documentation including OSHA forms and their NAICS code. The related federal contract opportunity is from the Department of Veterans Affairs for updating elevators at a Veterans Health Administration facility under solicitation number 36C25024B0015.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment XI - Additional RFI Question and Answer.docx | DOCX document | |
| Attachment XII - UPDATED Bid Opening Call-in Information.docx | DOCX document | |
| 36C25024B0015 0002.docx | DOCX document | |
| Attachment IX - RFI Questions and Answers.docx | DOCX document | |
| Attachment X - Bid Opening Call-in Info.docx | DOCX document | |
| 36C25024B0015 0001.docx | DOCX document | |
| Attachment III - DBA WD.pdf | ||
| 36C25024B0015_2.docx | DOCX document | |
| Attachment VII - Site Visit Memo Update Service Elevator.pdf | ||
| Attachment I - RFI Template.pdf | ||
| ATTACHMENT IV - VHA Directive 1192 01.pdf | ||
| Attachment VI - Design Manual - Elev.pdf | ||
| Attachment V - Limitations on Subcontracting (JAN 2023).pdf |
Show all 13
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Solicitation # 36C25024B0015.
Company Name: ______________________________________________
Address: _____________________________________________________
Telephone: ______________________ Fax: ________________________
Email: _______________________________________________________
Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
CATEGORY 2020 2021 2022
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 an explanation for any violations.
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 a 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):
http://www.osha.gov/pls/publications/publication.html
Pre-Award Contractor Safety and Environmental Record Evaluation Form
File details come from the government source that posted it. Updated .