Attch F_EMR Form.pdf
PDF 129 KB Posted
- Solicitation number
- 36C25622R0140
About this file
This solicitation is for the construction of an approximately 2,600 gross square foot interior space for a new satellite inpatient dialysis unit at the North Little Rock Veterans Affairs Medical Center. Offerors must provide a price breakdown by construction division including materials, labor, equipment, and total costs. The solicitation also requires general liability and insurance costs, overhead and profit, and bond costs to be included to determine the overall project total cost. The solicitation was issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16 for project number 598-18-107 to construct the inpatient dialysis unit addition at the Eugene Towbin Campus in North Little Rock, Arkansas. Responses are due based on the solicitation documentation provided however no specific due date is mentioned.
View the file
Other files
Show all 31
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
36C25622R0140
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 2019 2020 2021 2022 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):
http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .