Contractor EMR Certification Form.pdf
PDF 88 KB Posted
- Solicitation number
- 36C25021B0070
About this file
This document contains a federal contract opportunity notice and related contractor evaluation form. The notice is for project number 539-21-106 to replace expansion joints and update finishes in public places at the Cincinnati VA Medical Center, with a period of performance of 365 calendar days from notice to proceed. Work includes replacement of expansion joint components and floor, wall, and ceiling finishes throughout building 1. The project value is between $2,000,000 and $5,000,000, NAICS code 238220 for plumbing, heating and AC, and business size standard of $16.5 million applies. The solicitation will be issued as a 100% set-aside for service-disabled veteran-owned small businesses, which must be registered and verified on VIP, SAM, and perform a minimum of 15% of construction work. The related contractor form requires safety and environmental records for the past three years, including OSHA 300 forms, violation details, and experience modification rate below 1.0.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| RFI 1-AE Response.pdf | ||
| Wage Determination OH20210082 07-30-21.txt | TXT text file | |
| Virtual Bid Opening Call-In Information.pdf | ||
| 36C25021B0070 0003.docx | DOCX document | |
| 36C25021B0070 0002.docx | DOCX document | |
| Expansion Joint Specs (07 19 2021).pdf | ||
| Pre-Bid Sign-In Sheet (9-09-21).pdf | ||
| 36C25021B0070 0002.docx | DOCX document | |
| Expansion Joints Dwgs (07 19 2021).pdf | ||
| 36C25021B0070 0001.docx | DOCX document | |
| Drawings 04 14 2021.pdf | ||
| 36C25021B0070_1.docx | DOCX document | |
| Wage Determination OH20210010 - 06-18-21.pdf | ||
| Technical Specifications.pdf | ||
| RFI Form.docx | DOCX document |
Show all 15
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Contractor Safety and Environmental Record Evaluation Form
Company Name:
Address:
Telephone: Fax:
Email:
Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2018 2019 2020
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: 238220
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 .