Attch 6 Contractor EMR Certification Form.docx
DOCX document 27 KB Posted
- Solicitation number
- 36C24922R0104
About this file
This federal solicitation requests proposals for the renovation of a pathology laboratory at the Louisville VA Medical Center located in Louisville, Kentucky. Offerors must provide one electronic copy of a completed SF-1442 offer form, bid bond, representations and certifications, and contractor EMR certification documents by November 21, 2022 at 1:00PM Central Time. The project is set aside for service-disabled veteran-owned small businesses and has an estimated value between $250,000 to $500,000. All offerors must be registered in the System for Award Management database and comply with background check, E-Verify, and past performance reporting requirements. The selected contractor will be responsible for safety and environmental recordkeeping, insurance documentation, and records management policies in accordance with Federal Acquisition Regulation and National Archives standards.
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Other files
| File | Type | Posted |
|---|---|---|
| Addendum 1 Safety Requirements.pdf | ||
| 36C24922R0104 0004.docx | DOCX document | |
| Addendum 1 Drawings.pdf | ||
| Addendum 1 List of Drawings Sheets.pdf | ||
| Addendum 1 General Requirements.pdf | ||
| Attachment 9 Baker BSL hood-Quote 1-24-2021.pdf | ||
| Attachment 10 ME-Series-Manual-2015.pdf | ||
| Attachment 8 Specification ME-200 Grossing Station.docx | DOCX document | |
| 36C24922R0104 0003.docx | DOCX document | |
| 36C24922R0104 0002.docx | DOCX document | |
| 36C24922R0104 0001.docx | DOCX document | |
| Attch 2 Drawings 603-22-602 Renovate Pathology Lab 08-19-2022.pdf | ||
| Attch 4 WD KY20220093 dated 08-05-2022.pdf | ||
| Attch 3 Spec 603-22-602 Renovate Pathology Lab 100_ BD.pdf | ||
| Attch 5 Past Performance Questionaire.docx | DOCX document | |
| 36C24922R0104_1.docx | DOCX document | |
| Attch 1 SOW 603-22-602 Renovate Pathology Lab Final.docx | DOCX document | |
| Attch 7 Calc of Self Performed Work General Contractor.xlsx | XLSX spreadsheet |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Solicitation 36C24922B0018
Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2019 |
| 2020 |
| 2021 |
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: 238210
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 .