Contractor Certification Regarding Safety and Environmental.docx
DOCX document 13 KB Posted
- Solicitation number
- 36C25021B0036
About this file
This document contains a contractor certification form regarding safety and environmental compliance for a project to renovate the nuclear medicine department at the Richard L. Roudebush VA Medical Facility in Indianapolis, Indiana. The form requests information on any OSHA violations incurred by the contractor within the past three years and requires an explanation for any serious, willful, or repeat violations. It also requires disclosure of the contractor's current insurance experience modification rate along with a supporting letter from their insurance carrier. By signing the form, the contractor certifies their compliance with safety and environmental requirements for solicitation number 36C25021B0036 issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10 for renovation services.
View the file
Other files
Show 40 more
Latest 50 of 66 listed here. See the rest on GovTribe.
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: 583-20-102
| 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 .