Contractor Certification Regarding EMR.pdf
PDF 35 KB Posted
- Solicitation number
- 12905B21Q0011
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Contractor Certification Regarding Project: TBD
2017 2018 2019 2020 Number of serious, willful, or repeat violations from OSHA within the last 4 years. Please attach explanation for any violations. (Four serious, one repeat, or one willful violation could result in being determined non-responsible.)
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: ______________________________________________
Typed Name: ______________________________________________________
Title: ______________________________________________________
Contractor Certification Regarding Project: TBD
File details come from the government source that posted it. Updated .