Contractor Certification Regarding Safety and Environmental.pdf
PDF 79 KB Posted
- Attached to
- Y1DA--Expand First Floor B-1 for PACT - 610-311
- Solicitation number
- 36C25020B0004
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 company's current insurance experience modification rate, to be supported by a signed letter from the insurance carrier.
The related federal contract opportunity is solicitation number 36C25020B0004 from the Department of Veterans Affairs Veterans Health Administration to expand the first floor of building B-1 for PACT at location 610-311. No further details are provided on the required scope of work, response deadline, or award timing.
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Contractor Certification Regarding Project: 610-311
2017 2018 2019
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 .