ATTACHMENT - III - Contractor EMR Certification Form.docx
DOCX document 17 KB Posted
- Attached to
- Z1DA--Improve Security All Bldgs 610-15-105 Federal contract opportunity
- Solicitation number
- 36C25020B0071
About this file
This notice solicits bids for a construction project to improve security at all buildings at the Northern Indiana HealthCare System VA Medical Center in Marion, Indiana. The project has a magnitude between $500,000 and $1,000,000, and bids are due approximately 30 days after the solicitation is posted on August 17, 2020. The project is a 100% set-aside for Service-Disabled Veteran-Owned Small Businesses, who must be small under NAICS code 236210 with a size standard of $16.5 million. Bidders must be able to provide their OSHA 300 forms from 2016-2019, safety violation history for the past three years, current experience modification rate at or below 1.0, and perform a minimum of 25% of the construction work. The construction period may not exceed 180 calendar days from receipt of notice to proceed. The Department of Veterans Affairs is the contracting agency.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25020B0071 0002.docx | DOCX document | |
| RFI 7.pdf | ||
| RFI 4.pdf | ||
| RFI 2.pdf | ||
| RFI 6.pdf | ||
| RFI 5.pdf | ||
| RFI 1.pdf | ||
| 36C25020B0071 0001.docx | DOCX document | |
| RFI 3.pdf | ||
| ATTACHMENT - II - 610-15-105 Improve Security - Drawings.pdf | ||
| ATTACHMENT - VI - Wage Determination IN20200002 7-24-2020.pdf | ||
| ATTACHMENT - IV - RFI Form Solicitaton.docx | DOCX document | |
| ATTACHMENT - V - Site Visit Letter of Instruction For Potential Site Visit Attendees.docx | DOCX document | |
| 36C25020B0071.docx | DOCX document | |
| ATTACHMENT - I - 610-15-105 Improve Security - Specifications.pdf |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Solicitation 36C25020B0071:
Company Name: Address: Telephone: Fax: Email: Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2016 |
| 2017 |
| 2018 |
| 2019 |
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.
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 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):
File details come from the government source that posted it. Updated .