Contractor EMR Certification Form 2020.pdf
PDF 106 KB Posted
- Solicitation number
- 36C25020B0052
About this file
This document contains a pre-solicitation notice and related solicitation for corrective water distribution work at multiple buildings on the Battle Creek, Michigan Veterans Affairs Medical Center campus. The solicitation will be issued on June 29, 2020 as a 100% Service-Disabled Veteran Owned Small Business set-aside for project number 515-18-107 entitled "Correct Water Distribution Deficiencies Legionella." The work includes general construction and alterations to remove existing structures and construct corrections to address water distribution deficiencies. Specific work includes installation of water treatment systems, re-piping and re-insulation where necessary, installation of continuous temperature, pH and chlorine monitoring points, replacement of various plumbing fixtures, and elimination of unused fixtures and piping. The period of performance is 462 calendar days from notice to proceed. The North American Industry Classification Code is 236220 and size standard is $39.5 million. The estimated value is between $2-5 million. The government will award a firm fixed price contract.
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Other files
| File | Type | Posted |
|---|---|---|
| Specifications.pdf | ||
| Drawings - 2 of 3.pdf | ||
| Request For Information Form 515-18-107.pdf | ||
| 36C25020B0052_1.docx | DOCX document | |
| Statement of Work.pdf | ||
| Drawings - 3 of 3.pdf | ||
| Wage Determination MI20200079 01-03-2020.pdf | ||
| Drawings - 1 of 3.pdf |
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Text version
Pre-Award Contractor Experience Modification Rate (EMR) Form
Information regarding your EMR is being sought in conjunction with your offer applicable to Solicitation 36C25020B0052 to assist in making an initial determination of responsibility for any potential awardee in accordance with FAR 9.104-1(e) which states that “to be determined responsible, a prospective contractor must have the necessary organization, experience, accounting and operational controls, and technical skills including safety programs applicable to materials to be produced or services to be performed by the prospective contractor and subcontractors.”
Company Name: ______________________________________________
Address: _____________________________________________________
Telephone: ______________________ Fax: ________________________
Email: _______________________________________________________
Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information for the past three calendar years:
Category 2016 2017 2018 2019
Number of man hours (jobsite and office).
Number of cases involving days away from work, restricted activity, or both (Column H and I of OSHA 300).
Days away, restricted, or transferred rate (# of days away, restricted, or transferred cases x 200,000/# of man hours)
(DART Rate).
Number of serious, willful, or repeat violations from OSHA within the last 3 years. Please attach explanation for any violations.
2. Please attach copies of the following documents: 2019 OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page: http://www.osha.gov/pls/publications/publication.html.
3. Provide six-digit North American Industrial Classification System (NAICS) Code for this acquisition: __________________________________
4. The name and title of the person who administers your company’s Safety and Health
Program? ____________________________.
5. Your company’s Insurance Experience Modification Rate (EMR): ______ http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .