CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL.pdf
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- Solicitation number
- 36C26121R0087
About this file
This document contains a contractor certification form and details of a related federal contract opportunity.
The contractor certification form requires bidders to disclose the number of serious, willful or repeat OSHA violations in the past three years and provide an explanation for any violations. It also requires contractors to disclose their current insurance Experience Modification Rate and provide supporting documentation from their insurance carrier.
The related federal contract opportunity is solicitation number 36C26121R0087 for water monitoring and treatment services. The solicitation was issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21. The description provided indicates it is a new solicitation for water monitoring and treatment services but does not include details on pricing, response dates, place of performance or other contract requirements.
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CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL
Contractor Certification Regarding Project: 612-20-015
2015 2016 2017 2018
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 disqualifies the contractor.)
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 .