Attachment VIIII - EMR.docx
DOCX document 15 KB Posted
- Attached to
- Z2NE--544-22-115 Replace Water and Fire Piping Loop Federal contract opportunity
- Solicitation number
- 36C24726R0074
About this file
This is a Pre-Award Contractor Safety and Environmental Record Evaluation Form for Solicitation #36C24726R0074, a Department of Veterans Affairs project to replace water and fire piping systems at Columbia VA Health Care System in South Carolina.
The form requires contractors to submit comprehensive safety and environmental documentation including OSHA 300 and 300a Forms for three years (2023-2025) showing man-hours worked, cases involving days away from work or restricted activity, and DART rates calculated using the standard formula. Contractors must disclose the number of serious, willful, or repeat OSHA violations within the last three years with explanations, identify their six-digit NAICS code, and provide the name of the individual administering their company's Safety and Health Program. Additionally, contractors must supply their current Insurance Experience Modification Rate (EMR). This evaluation is part of the pre-award process for a project involving site preparation, demolition, and replacement of domestic water and fire piping systems throughout the Columbia VAMC campus and interior work in Buildings 100 and 100A, designed to meet current VA standards and reduce service interruptions.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C24726R0074 0004.pdf | ||
| Copy of 544-22-115 - Bid Sheet.xlsx | XLSX spreadsheet | |
| 36C24726R0074 0003.pdf | ||
| Attachment I - WD Building.pdf | ||
| 36C24726R0074 0002 Amendment.pdf | ||
| 36C24726R0074 0001 Amendment.pdf | ||
| Attachment VI - SF24-23a Bid Bond.pdf | ||
| Attachment VII - Class Deviation from the Federal Acquisition Regulation.pdf | ||
| 36C24726R0074_1 Final Rev.pdf | ||
| Attachment I - WD.pdf | ||
| Attachment V - 852.219-75 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING.pdf | ||
| Attachment II - Bid Docs Drawings.pdf | ||
| Attachment IV - Bid Docs Spec Vol 2.pdf | ||
| Attachment III - Bid Docs Spec Vol 1.pdf | ||
| Attachment X PPQ .docx | DOCX document | |
| Attachment VIII - Compliance with Executive order 13899.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 #36C24726R0074 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2023 |
| 2024 |
| 2025 |
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 .