Contractor Certification Regarding Safety and Environmental.pdf

This document contains a contractor certification form and information on a related federal contract opportunity. The contractor certification form requires the contractor to disclose the number of serious, willful, or repeat OSHA violations in the last three years and provide an explanation for any violations, as four or more could result in a determination of non-responsibility. It also requires disclosure of the contractor's current insurance experience modification rate and support from their insurance carrier.

The related federal contract opportunity is solicitation number 36C25022B0009 to provide all tools, equipment, materials, labor and supervision necessary to complete a water infiltration correction project numbered 610-20-102 at the Northern IN VA Medical Center in Marion, Indiana. The requirement refers to attached drawings, specifications and a statement of work for a full description. The contracting agency is the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10.