Contractor EMR Certification Form.docx
DOCX document 15 KB Posted
- Solicitation number
- 36C24922B0033
About this file
This document contains a solicitation for roof replacement services at a Veterans Affairs medical center in Nashville, Tennessee. The solicitation is a 100% set-aside for service-disabled veteran-owned small businesses, with a project magnitude between $500,000 and $1,000,000. The selected contractor will have 61 calendar days to complete roof replacement for Building 1, including necessary construction, alterations and removal work. The solicitation includes details on wage determinations, registration requirements, performance and payment bonds, security background checks, and other standard contracting terms. Submissions are due by December 14, 2022 and the virtual bid opening will be held on that date at 1:00 PM Central Time.
The statement of work provides additional requirements such as warranty terms, work hours and scheduling, safety protocols, site access and parking procedures, housekeeping standards, and inspection processes. The contractor must have a superintendent on-site at all times and coordinate all work in advance with the contracting officer's representative. The selected offeror will be responsible for furnishing all necessary labor, materials and equipment to complete the roof replacement project according to plans and specifications.
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Other files
| File | Type | Posted |
|---|---|---|
| Pre-bid site visit 11-22-2022 sign-in sheet.pdf | ||
| 36C24922B0033 0001.docx | DOCX document | |
| Specs 626-21-501.pdf | ||
| WD TN TN20220178 Dated 09-02-2022.pdf | ||
| 36C24922B0033_1.docx | DOCX document | |
| RFI Form - Nashville Roof Replacement.pdf | ||
| Calculation of Self Performed Work.docx | DOCX document | |
| Drawings Roof Replacement 626-21-501.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 36C24922B0033 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 |
| 2019 |
| 2020 |
| 2021 |
| 2022 |
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: current 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): ______
File details come from the government source that posted it. Updated .