Contractor Certification Regarding Safety and Environmental 610-24-509.docx

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Install Isolation Filter System 610-24-509
Solicitation number
36C25024B0044
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This document is a Contractor Certification Regarding Safety and Environmental for Federal Contract Opportunity 610-24-509. The certification requires the contractor to disclose any serious, willful, or repeat violations from OSHA within the last 3 years and provide an explanation. The contractor must also provide their current Insurance Experience Modification Rate (EMR) supported by a signed letter from their insurance carrier. The related Federal Contract Opportunity is for installing (34) VA-provided negative/positive pressure isolation units with UV function, Accustat, and EchoPhan blower modules in building 172 at the VA Northern Indiana Health Care - Marion Campus. The work must be completed within 120 calendar days from the notice to proceed. The solicitation number is 36C25024B0044 and only electronic bids are being accepted via email to Colin.Remes@VA.gov.

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Other files

File Type Posted
36C25024B0044 Bid Opening Call in Information 0003.docx DOCX document
36C25024B0044 0002.docx DOCX document
RFI part 1.docx DOCX document
610-24-509 Site Visit Attendance.pdf PDF
610-24-509 - Complete Drawings.pdf PDF
36C25024B0044 0001.docx DOCX document
RFI Form 36C25024B0044.doc DOC document
610-24-509 - Specifications.pdf PDF
EMR 36C25024R0095.docx DOCX document
RFI Form 36C25024R0095.doc DOC document
610-24-509 - SOW.doc DOC document
IN 2024 Wage Determination.txt TXT text file
VHA Directive 1192 01.pdf PDF
IFB 36C25024B0044.pdf PDF
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Contractor Certification Regarding Project: 610-24-509

2021
2022
2023

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 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: ______________________________________________________

File details come from the government source that posted it. Updated .