Contractor Certification Regarding Safety and Environmental.docx
DOCX document 13 KB Posted
- Attached to
- Replace C-Wing Sanitary Federal contract opportunity
- Solicitation number
- 36C25022B0064
About this file
This document contains a contractor certification form and details of a related federal contract opportunity for replacement of sanitary facilities. 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 related federal contract opportunity is solicitation number 36C25022B0064 to provide all labor, equipment, materials and supervision necessary to complete the Replace C-Wing Sanitary project at the Richard L. Roudebush VA Medical Center in Indianapolis, Indiana. The requirement includes replacing sanitary facilities in the specified wing according to the attachments, specifications and statement of work. The contracting agency is the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amendment A00001 36C25022B0064.pdf | ||
| Site Visit Sign-in Sheet.pdf | ||
| 583-22-512 Combined Specs.pdf | ||
| C - Wing Sanitary Drawings.pdf | ||
| Wage Determination.txt | TXT text file | |
| 36C25022B0064 Solicitation Document.pdf | ||
| NU FLOW Specs for slipp linning.pdf | ||
| RFI Form.doc | DOC document |
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Contractor Certification Regarding Project: 583-22-512
| 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 .