Contractor EMR Certification Form.pdf
PDF 159 KB Posted
- Solicitation number
- 36C24921B0013
About this file
This solicitation document requests bids for a construction project to replace a building roof at the James H. Quillen VA Medical Center. Key details include:
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The project scope involves furnishing all labor, materials, equipment, and supervision to complete roof replacement for Building 77 according to drawings and specifications. Bids are due by February 1, 2022 and the period of performance is 180 days.
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The solicitation is set aside 100% for service-disabled veteran-owned small businesses. The required NAICS code is 238160 for roofing contractors and the small business size standard is $16.5 million.
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The contractor must complete an EMR certification form providing OSHA record information and insurance experience modification rate. Safety and environmental violations from the past three years must also be reported.
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Standard contract clauses are included regarding payment and performance bonds, system for award management registration, veterans' employment reporting, conformance with environmental management systems, and records management policies.
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The contracting agency is the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 9. Work will be performed at the James H. Quillen VA Medical Center in Mountain Home, Tennessee.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24921B0013 0006.pdf | ||
| 36C24921B0013 0005.pdf | ||
| 36C24921B0013 0004.pdf | ||
| Specification 073126.pdf | ||
| 36C24921B0013 0003.pdf | ||
| 32 18 27 -02792-PLAYGROUND SURFACING - POURED RUBBER.pdf | ||
| 36C24921B0013 0002.pdf | ||
| 36C24921B0013 0001.pdf | ||
| Specifications.pdf | ||
| Drawing Part-5.pdf | ||
| Drawing Part-7.pdf | ||
| Drawing Part-4.pdf | ||
| Drawing Part-11.pdf | ||
| Drawing Part-1.pdf | ||
| 36C24921B0013_3.docx | DOCX document | |
| Drawing Part-9.pdf | ||
| RFI Form - Install Historic Site Enhancements.pdf | ||
| Drawing Part-6.pdf | ||
| Drawing Part-8.pdf | ||
| Drawing Part-12.pdf | ||
| Drawing Part-10.pdf | ||
| WD 20220191 9-2-2022.pdf | ||
| Drawing Part-3.pdf | ||
| Drawing Part-2.pdf | ||
| Header - List of Attachments.txt | TXT text file | |
| Drawing Part-13.pdf |
Show all 26
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Solicitation: 36C24921B0013 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2019 2020 2021
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.
Please attach copies of the following documents: OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page:
http://www.osha.gov/pls/publications/publication.html.
2. Provide six-digit North American Industrial Classification System (NAICS) Code for this acquisition: 236220
3. Who administers your company’s Safety and Health Program?
4. 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 .