Contractor Certification Regarding Safety and Environmental.docx
DOCX document 13 KB Posted
- Solicitation number
- 3625022B0030
About this file
This document contains a contractor certification form and details of a related federal contract opportunity for renovation work. 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 their carrier.
The federal contract opportunity is solicitation number 3625022B0030 to renovate the second floor of Building 9 at the VA Northern Indiana Health Care facility in Marion, Indiana. The contractor will provide all labor, equipment, materials and supervision necessary to complete demolition of existing structures and installation of new walls, doors, windows, ceiling grid, electrical, plumbing, fire safety, data and finishes. The opportunity is issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25022B0030 Solicitation Document.pdf | ||
| Drawings.pdf | ||
| Flu Directive.pdf | ||
| Wage Determination.pdf | ||
| RFI Form.doc | DOC document | |
| Specifications.pdf | ||
| VHA Supplemental Contract Requirements for Ensuring Adequate COVID-19 Safety Protocols for Federal Contractors rev2.pdf |
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Text version
Contractor Certification Regarding Project: 610-20-523
| 2019 |
| 2020 |
| 2021 |
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 .