CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL.docx
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- Solicitation number
- 36C26122R0053
About this file
This document contains a contractor certification form and details of a federal contract opportunity for HVAC and flooring work. The contractor certification form requests information on any OSHA violations in the past three years, as well as the contractor's current insurance EMR. The federal contract opportunity is solicitation number 36C26122R0053 from the Department of Veterans Affairs for HVAC requirements and sterile storage humidity work at a VA medical center. The project will update the HVAC system and flooring for the Sterile Process Service area while also providing swing space for the service during construction. Plans and specifications are provided for the HVAC, swing space, and flooring components.
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CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL
Contractor Certification Regarding Project: 640-21-300 Patient Privacy
| 2016 |
| 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 disqualifies the contractor.)
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 .