Contractor Certification Regarding Safety and Environmental.pdf
PDF 106 KB Posted
- Attached to
- Correct Legionella Deficiencies Federal contract opportunity
- Solicitation number
- 36C25021B0016
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 in the past three years, the company's current insurance experience modification rate, and signature of a company representative.
The related federal contract opportunity is solicitation number 36C25021B0016 to correct Legionella deficiencies at the Northern IN VA Healthcare System in Marion, Indiana. The contractor must provide all tools, equipment, materials, labor and supervision to complete the project. This is a 100% set-aside for a Service-Disabled Veteran Owned Small Business. The agency is the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amendment 0003.pdf | ||
| 610-18-103 Pre-Bid Solicitation Site Visit Sign in Sheet.pdf | ||
| 36C25021B0016 0002 Posting.pdf | ||
| 36C25021B0016 0001.pdf | ||
| 610-18-103 Legionella - Drawings.pdf | ||
| 610-18-103 Legionella - Specifications.pdf | ||
| RFI Form.pdf | ||
| 36C25021B0016_1.pdf | ||
| IN20210002 WD.pdf |
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Text version
Contractor Certification Regarding Project: 610-18-103
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 .