Attachment - III - Contractor Certification Regarding Safety and Environmental.docx
DOCX document 13 KB Posted
- Attached to
- Replace AHUs and Condensing Units 610A4-21-203
- Solicitation number
- 36C25023B0052
About this file
This document is a contractor certification form required for the federal contract opportunity Solicitation Number 36C25023B0052 to replace AHUs and condensing units at project number 610A4-21-203 for the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10. The contractor certification form requires bidders to disclose the number of serious, willful, or repeat OSHA violations in the last three years and attach an explanation for any violations, as four serious, one repeat, or one willful violation could result in being deemed non-responsible. Bidders must also disclose their current insurance EMR as verified by their insurance carrier on letterhead. The signature and contact information of the certifying official is also required.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25023B0052 Amendment 3.pdf | ||
| 36C25023B0052 P0002.pdf | ||
| Asbestos and Lead Report Ft. Wayne.pdf | ||
| 36C25023B0052 Amendment 1.pdf | ||
| Attachment - V -Wage Determination.pdf | ||
| Attachment - IV - RFI Form.doc | DOC document | |
| 36C25023B0052 IFB.pdf | ||
| Attachment - I -AHU Drawings.pdf | ||
| Attachment - VI - Contractor EMR Certification Form.docx | DOCX document | |
| Attachment - II - Design Firm Specs.pdf |
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Text version
Contractor Certification Regarding Project: 610A4-21-203
| 2019 |
| 2020 |
| 2021 |
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 violation could result in being determined non-responsible.)
Company’s Current Insurance Experience Modification Rate (EMR) = _____________ (Note: Contractor must support the EMR with a signed letter from Insurance Carrier on their letterhead.)
Signature: ______________________________________________
Typed Name: ______________________________________________________
Title: ______________________________________________________
File details come from the government source that posted it. Updated .