Contractor Certification Regarding Safety and Environmental.docx
DOCX document 13 KB Posted
- Solicitation number
- 36C25020B0051
About this file
This document contains a contractor certification form and details of a federal contract opportunity for correcting Legionella deficiencies and providing monitoring services. The contractor certification form requests information on any OSHA violations in the past three years and the company's current insurance EMR rating, to be supported by a letter from the contractor's insurance carrier.
The federal contract opportunity is amendment 02 to solicitation number 36C25020B0051 from the Department of Veterans Affairs. The contractor will provide all tools, equipment, parts, materials, labor and supervision necessary to complete corrective work for Legionella deficiencies and implement monitoring services at the Northern IN VA Healthcare System located at 2121 Lake Avenue, Fort Wayne, IN 46805. The statement of work provides more details on the project requirements.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25020B0051 0002.pdf | ||
| Consolidated Pre-bid RFIs_Answered.pdf | ||
| Ft. Wayne and Marion IN VAMC - Asbestos Reinspection Report - August 2016.pdf | ||
| 36C25020B0051 0001.pdf | ||
| 610A4-18-104 PreBid Sign-In 20200715.pdf | ||
| RFI Responses.pdf | ||
| 05 Combined Specs.pdf | ||
| Wage Rate IN20200002.pdf | ||
| RFI Form.doc | DOC document | |
| 06 Drawings.pdf | ||
| 36C25020B0051.pdf |
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Text version
Contractor Certification Regarding Project: 610A4-18-104
| 2017 |
| 2018 |
| 2019 |
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 .