CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL.docx

DOCX document 13 KB Posted

Attached to
Project 570-19-107 | Improve Site Access and Physical Security Deficiencies Federal contract opportunity
Solicitation number
36C26123R0110
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21

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Written by GovTribe AI ·

This document is a contractor certification form for a Department of Veterans Affairs project to improve site access and physical security deficiencies. The form requires contactors to disclose the number of OSHA and EPA violations within the last three years along with explanations for any violations. It also requests the company's current insurance experience modification rate supported by a signed letter from their insurance carrier. The related federal contract opportunity is solicitation number 36C26123R0110 for Project 570-19-107 to improve site access and physical security deficiencies through the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21.

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SF30- Clarification on Due Date.pdf PDF
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36C26123R0110 RFIs.pdf PDF
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Site Visit Attendance Roster.pdf PDF
RFI Atch 2- AS 101.pdf PDF
SF30 Amend 0001- Clarify Site Visit Date.pdf PDF
CA Wage Determination 20230018 - 09292023.pdf PDF
VA Specifications- Final.pdf PDF
01_General Drawings (1).pdf PDF
03_Landscape Drawings (1).pdf PDF
07_FP Topo and Misc Drawings (1).pdf PDF
Appendix A Revised 10-6-23.pdf PDF
APPENDIX C.pdf PDF
04_Architectural Drawings (1).pdf PDF
05_Structural Drawings (1).pdf PDF
06_MEP Drawings (1).pdf PDF
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Supplemental Price Breakdown.xlsx XLSX spreadsheet
02_Civil Drawings (1).pdf PDF
APPENDIX B.pdf PDF
Large Business Subcontracting Plan Template.docx DOCX document
001.RFP 36C26123R0110 Improve Site Access and Security Deficiencies.pdf PDF
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CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL

Contractor Certification: Project 570-19-107 Improve Site Access and Security Deficiencies

2020
2021
2022
2023

Number of serious, willful, or repeat violations from OSHA within the last 3 years. Please attach explanation for any violations.

Number of serious, willful, or repeat EPA violations within the last 3 years. Please attach explanation for any violations.

(Four serious, one repeat, or one willful violation 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 .