Contractor Certification Regarding Safety and Environmental.docx
DOCX document 13 KB Posted
- Attached to
- Replace Panic Hardware Bldg 1 Project 610A4-21-204 Federal contract opportunity
- Solicitation number
- 36C25024B0013
About this file
This document is a contractor certification form required for the federal contract opportunity to replace panic hardware at Building 1 under project number 610A4-21-204. The contractor certification form requests information on any OSHA violations incurred by the contractor within the last three years and an explanation for any serious, willful, or repeat violations. It also requires disclosure of the contractor's current insurance experience modification rate and signature by a company representative.
The related federal contract opportunity is solicitation number 36C25024B0013 issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10 to replace panic hardware at Building 1 under project number 610A4-21-204. The opportunity type is listed as a solicitation.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amendment 4.pdf | ||
| Amendment 3.pdf | ||
| RFI Responses.docx | DOCX document | |
| Amendment 2.pdf | ||
| Site Visit Sign-in Sheet.pdf | ||
| 36C25024B0013 A0001 - NAICS Change.pdf | ||
| ACM Report for Fort Wayne VA Campus.pdf | ||
| Lead Report for Fort Wayne VA Campus.pdf | ||
| Drawings.pdf | ||
| Specifications.pdf | ||
| RFI Form.doc | DOC document | |
| Wage Determination.txt | TXT text file | |
| 36C25024B0013 Solicitation Document.pdf | ||
| Flu Directive.pdf |
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Text version
Contractor Certification Regarding Project: 610A4-21-204
| 2020 |
| 2021 |
| 2022 |
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 .