ATTACHMENT M - EMR FORM.pdf

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Z2DB--PROJ 675-104 Design Build (DB) Renovate Lakemont 225 for OIG
Solicitation number
36C24822R0090
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This solicitation requests design-build services for the renovation of space 225 at the Lakemont campus of the Orlando VA Healthcare System. The Department of Veterans Affairs VISN 8 seeks to provide all design and construction services for the project including labor, materials, tools, equipment, and supervision. The period of performance is 186 calendar days from notice to proceed. The project budget is between $100,000 and $250,000. This is a 100% set-aside for verified Service-Disabled Veteran-Owned Small Businesses. The associated NAICS code is 236220 and the product service code is Z2DB. The evaluation will use the two-phase design-build selection process and best value determination. Proposals are due from interested and registered SDVOSBs by the date specified in solicitation number 36C24822R0090. Contractors will be expected to comply with environmental laws and policies including waste minimization.

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Other files

File Type Posted
36C24822R0090 0001.docx DOCX document
Amendment 36C24822R0090 0001.pdf PDF
ATTACHMENT J - CONTRACT PROGRESS SCHEDULE.docx DOCX document
ATTACHMENT G - FLOOR PLANS DRAWINGS.zip ZIP file
ATTACHMENT E - 01 42 19 REFERENCE STANDARDS.pdf PDF
ATTACHMENT H - DAVIS BACON ACT WD FL20220218.pdf PDF
ATTACHMENT C - 01 32 16 17 PROJECT SCHEDULES.pdf PDF
ATTACHMENT B - 01 32 16 16 NETWORK ANALYSIS SCHEDULES DESIGN-BUILD ONLY.pdf PDF
ATTACHMENT A - 01 00 00 GENERAL REQUIREMENTS.pdf PDF
36C24822R0090_1.docx DOCX document
SOLICITATION 36C24822R0090.pdf PDF
ATTACHMENT L - PAST PERFORMANCE QUESTIONNAIRE.docx DOCX document
ATTACHMENT K - EXPERIENCE INFORMATION SHEET.pdf PDF
ATTACHMENT D - 01 33 23 SHOP DRAWINGS PRODUCT DATA AND SAMPLES.pdf PDF
ATTACHMENT I - LIMITATION ON SUBCONTRACTING CERTIFICATION.docx DOCX document
ATTACHMENT F - 11 11 21 REQUEST FOR PROPOSAL TO DESIGN BUILD.pdf PDF
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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 2017 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. (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): _____________

S02 - ATTACHMENT M - EMR FORM (1 Page)

File details come from the government source that posted it. Updated .