Attachment - VA DIRECTIVE 7715 EMR 02 FORM.pdf
VA Directive PDF 526 KB Posted
- Solicitation number
- 36C26124R0094
About this file
This document is a VA Directive 7715 form, which requires contractors bidding on a federal contract opportunity to provide information about their safety and environmental record, as well as their current Experience Modification Rate (EMR).
The key details are:
- Contractors must have no more than three serious, one repeat, or one willful OSHA or EPA violations in the past 3 years, and an EMR of 1.0 or less to be eligible for consideration.
- Contractors must submit a self-certification on company letterhead detailing their safety and environmental record, as well as their current EMR from their insurance carrier.
- If a contractor's EMR is above 1.0, they must provide a written explanation from their insurance carrier describing the reasons and the anticipated date the EMR may be reduced to 1.0 or below.
- This information is required to be submitted with the offer for the federal contract opportunity, which is for construction services to replace flooring in the OR, PACU, and Special Procedures areas. The solicitation number is 36C26124R0094, the due date is December 19, 2024, and the contracting agency is the Department of Veterans Affairs Veterans Health Administration.
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Other versions and copies of VA Directive 7715
| File | Revision | Posted | Attached to |
|---|---|---|---|
| 18 - Safety VA Directive 7715 Rev 092023.pdf | Revision not stated | Y1DA--9th Floor MH Renovation WBVAMC | |
| 8. VA DIRECTIVE 7715 EMR 02 FORM.docx | Revision not stated | Z1DA-- Construction Renovate Outpatient Pharmacy and HVAC, Mather 612A4-19-016 |
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Text version
PER VHA DIRECTIVE 7715 (06 April 2017) - SAFETY & ENVIRONMENTAL RECORD
AND EXPERIENCE MODIFICATION RATE (EMR):
Contractor Certification Regarding Project:
To be eligible for consideration and award, the contractor shall have no more than three serious, or one repeat, or one willful OSHA or EPA violation(s) in the past 3 years and have an EMR of equal to or less than 1.0.
All Offerors shall submit the following information pertaining to their past Safety & Environmental Record and EMR with their offer.
1. SAFETY & ENVIRONMENTAL RECORD: A self-certification on company letterhead that the contractor has no more than three (3) serious, or one (1) repeat or one (1) willful OSHA or any EPA violation(s) in the past three years.
2. EMR: All Offerors shall submit information regarding their current EMR. This information shall be obtained from the Offerors’s insurance carrier and be furnished on the insurance carrier’s letterhead. If an Offeror’s EMR is above 1.0, Offeror shall submit a written explanation of the EMR from its insurance carrier furnished on the insurance carrier’s letterhead, describing the reasons for the EMR, and the anticipated date the EMR may be reduced to 1.0 or below.
2022 2023 2024 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.)
Number of violations from EPA within the last 3 years. Please attach explanation for any violations.
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:
Print Name: _________________________________________________
File details come from the government source that posted it. Updated .