Contractor Certification Regarding Safety and Environmental.docx
DOCX document 13 KB Posted
- Solicitation number
- 36C25022B0030
About this file
This document contains a contractor certification form and details of a related federal contract opportunity. The contractor certification form requests information on any OSHA violations from the past three years and the company's current insurance experience modification rate, to be supported by a signed letter from the contractor's insurance carrier.
The related federal contract opportunity is solicitation number 36C25022B0030 to renovate the second floor of Building 9 at the Northern IN VA Medical Center in Marion, Indiana. The contractor shall provide all tools, equipment, materials, labor and supervision necessary to complete the renovation project according to the attachments, drawings, specifications and statement of work. The contracting agency is the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10.
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Other files
| File | Type | Posted |
|---|---|---|
| Amendment 36C25022B0030 A00002.pdf | ||
| RFI Responses.docx | DOCX document | |
| 36C25022B0030 Solicitation Document.pdf | ||
| Amendment 36C25022B0030 A00001.pdf | ||
| Drawings.pdf | ||
| Remodel Bldg 9 Sign-in Sheet.pdf | ||
| Wage Determination.pdf | ||
| Specifications.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 .