CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL.docx

This is a Contractor Certification form regarding safety and environmental compliance for Project 459-24-001, the Modernize Generators project spanning 2023-2026. The form requires contractors to certify and disclose their safety and environmental violation history to the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21 for the Z2DZ--Modernize Generator Project (Solicitation Number 36C26126R0031) at the Honolulu campus.

Contractors must document the number of serious, willful, or repeat violations issued by OSHA within the last three years with attached explanations for any violations cited. Similarly, contractors must disclose any serious, willful, or repeat EPA violations from the same three-year period with supporting documentation. A disqualifying threshold is established: contractors with four serious violations, one repeat violation, or one willful violation are ineligible. Additionally, contractors must provide their current Experience Modification Rate (EMR) from their insurance carrier and support this figure with a signed letter on the carrier's letterhead. The form requires the contractor's authorized representative to sign and provide their typed name and title as certification of accuracy.