Contractor Certification Regarding Safety and Environmental.docx
DOCX document 13 KB Posted
- Solicitation number
- 36C25024B0003
About this file
This document contains a contractor certification form and details of a related federal contract opportunity for upgrade signage and wayfinding services. The contractor certification form requests company information including the number of any serious, willful, or repeat OSHA violations in the last three years and the current insurance EMR rating, to be supported by a letter from the contractor's insurance carrier.
The related federal contract opportunity is solicitation number 36C25024B0003 to provide all supervision, labor, materials, and equipment for replacing exterior and interior signage and installing banners at the Veterans Health Administration campus in Fort Wayne, Indiana. The requirement includes replacing post-mounted parking and campus signs, panel signs, informational signs, and building-mounted signs, as well as repairing landscaping and installing banners on light poles as needed. The contracting agency is the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10.
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Other files
| File | Type | Posted |
|---|---|---|
| Amendment 2.pdf | ||
| Amendment 1.pdf | ||
| Upgrade Signage and Wayfinding Site Visit Sign in Sheet SAM posting.pdf | ||
| Requests for Information SAM post.docx | DOCX document | |
| Solicitation Upgrade Signage and Wayfinding (IFB).pdf | ||
| EMR 36C25024B0003.docx | DOCX document | |
| Solicitation Upgrade Signage and Wayfinding (IFB).pdf | ||
| VHA Directive 1192 01.pdf | ||
| Wage Determination 610A4.txt | TXT text file | |
| 5-spec-upgrade signage and wayfinding.pdf | ||
| RFI Form 36C25024B0003.doc | DOC document | |
| 6-drawings-upgrade signage and wayfinding-cor notes.pdf |
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Text version
Contractor Certification Regarding Project: 610A4-22-208
| 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 .