Contractor Certification Regarding Safety and Environmental.docx
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- Solicitation number
- 36C25021B0020
About this file
This document contains a contractor certification form and details of a related federal contract opportunity for renovating a laboratory at a Veterans Health Administration facility. The contractor certification form requests information on any OSHA violations in the past three years and the company's current insurance EMR rating, to be signed by a company representative.
The federal contract opportunity is solicitation number 36C25021B0020 to renovate the Histology, Cytology and Molecular lab at the Richard L. Roudebush VHA Health Care System. The project number is 583-18-102. As a 100% set aside for Service-Disabled Veteran-Owned Small Businesses, the contractor shall provide all labor, materials and equipment to complete the renovations in accordance with the solicitation terms and applicable laws and regulations. The NAICS code is 236220 and the magnitude of the construction project is estimated between $2,000,000 to $5,000,000. The contracting agency is the Department of Veterans Affairs Veterans Health Administration VISN 10.
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Contractor Certification Regarding Project: 583-18-102
| 2018 |
| 2019 |
| 2020 |
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 .