Contractor Certification Regarding Safety and Environmental.docx

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Z2DZ--Replace Elevators Throughout Mather VA Medical Center | 612A4-22-001
Solicitation number
36C26123R0015
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This document outlines requirements for a federal contract to replace elevators at the Mather Medical Center campus of the Veterans Health Administration. The contractor will replace a total of seven elevators across two buildings in three construction phases. The contractor must provide new elevator systems, electrical work, and communication lines meeting all applicable safety codes. One elevator per building may be out of service at a time, with a maximum 30-day outage for buildings with a single elevator. The contractor must submit a phasing plan and commissioning documents for approval. All work must be done during daytime hours on weekdays with outage notifications 21 days in advance. The government agency will retain ownership of all records and data generated under the contract.

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CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL

Contractor Certification Regarding Project: 612A4-22-001

Title: Replace Elevators Throughout Mather Medical Center

PER VHA DIRECTIVE 7715 (06 April 2017): SAFETY & ENVIRONMENTAL RECORD AND EXPERIENCE MODIFICATION RATE (EMR): To be eligible for consideration and award, the contractor shall have no more than three serious, or one repeat, or one willful OSHA or EPA violation(s) in the past 3 years and have an EMR of equal to or less than 1.0.

All Offerors shall submit the following information pertaining to their past Safety & Environmental Record and EMR with their bid/proposal:

SAFETY & ENVIRONMENTAL RECORD: A self-certification on company letterhead that the bidder has no more than three (3) serious, or one (1) repeat or one (1) willful OSHA or any EPA violation(s) in the past three years. Include the following table and signature block.

2020
2021
2022

Number of serious, willful, or repeat violations from OSHA within the last 3 years.

Number of serious, willful, or repeat violations from EPA within the last 3 years

Signature:

Typed Name:

Title:

EMR: All offerors shall submit information regarding their current EMR. This information shall be obtained from the bidder’s insurance carrier and be furnished on the insurance carrier’s letterhead.

Company’s Current Insurance Experience Modification Rate (EMR) =

(Note: Contractor must support the EMR with a signed letter from Insurance Carrier on their letterhead.)

File details come from the government source that posted it. Updated .