Attachment IV - EMR Attachment.pdf
PDF 111 KB Posted
- Attached to
- Z1DA--583-19-205 - Upgrade Bldgs. 1, 19 & 21
- Solicitation number
- 36C25021B0025
About this file
This document provides details for a federal construction solicitation to upgrade buildings at the Roudebush VA Medical Center in Indianapolis. The solicitation seeks general construction services including demolition of existing structures and construction of new entrance vestibules and doors at three buildings. The work includes materials, labor, equipment and all resources to complete the upgrades according to provided drawings and specifications. The performance period is 120 days from notice to proceed and the total project value is estimated between $500,000 and $1,000,000. Requests for the invitation for bids should be submitted by February 4, 2020. The solicitation will be posted on February 4, 2021 with bids due 30-45 days later. This opportunity is 100% set aside for Service-Disabled Veteran-Owned Small Businesses.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25021B0025 0001.docx | DOCX document | |
| Attachment II - Revised Specifications.pdf | ||
| Attachment I - Revised Drawings.pdf | ||
| 36C25021B0025_1.docx | DOCX document | |
| Attachment V - RFI Attachment.pdf | ||
| Attachment I - Drawings.pdf | ||
| Attachment II - Specifications.pdf | ||
| Attachment III - DBA - IN20210002.pdf | ||
| Attachment VI - JA.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 # 36C25021B0025.
Company Name: ______________________________________________
Address: _____________________________________________________
Telephone: ______________________ Fax: ________________________
Email: _______________________________________________________
Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2018 2019 2020
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):
http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .