Contractor Certification Regarding Safety and Environmental.docx
DOCX document 13 KB Posted
- Attached to
- Z1DA--Remodel Fort Wayne Chapel 610A4-22-203
- Solicitation number
- 36C25024B0012
About this file
This document contains a contractor certification form and details of a related federal contract opportunity. The contractor certification form requests information on any OSHA violations from the past three years and the contractor's current insurance EMR rating, to be supported by a letter from their carrier.
The related federal contract opportunity is solicitation number 36C25024B0012 to remodel the chapel at the Fort Wayne VAMC. The contractor will provide all labor, equipment, materials and supervision necessary to complete the demolition and construction work as outlined in the drawings and specifications, including adherence to all infection control requirements. The opportunity is being offered by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 36C25024B0012 Amendment 0002.pdf | ||
| Pre-Bid Sign in sheet 610A4-22-203 Remodel Fort Wayne Chapel.pdf | ||
| 36C25024B0012 Amendment A00001.pdf | ||
| Specifications.pdf | ||
| VHA Directive 1192 01.pdf | ||
| WD IN20240002.txt | TXT text file | |
| RFI Form.doc | DOC document | |
| 36C25024B0012 Solicitation.pdf | ||
| Drawings.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Contractor Certification Regarding Project: 610A4-22-203
| 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 .