Contractor Evaluation Safety Guide OSHA-EMR.pdf
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- Solicitation number
- 36C10F20R0091
About this file
This document contains a pre-award contractor evaluation form and details of a federal contract opportunity for construction of a Central Utility Plant at the Dallas VA Medical Center.
The pre-award contractor evaluation form requests safety-related information from bidders, including OSHA recordable incident rates for the past three years, total manhours worked, copies of OSHA forms 300 and 300A, the bidder's NAICS code, safety program administrator contact information, and insurance experience modification rates. Bidders with an experience modification rate over 1.0 or a serious, willful, or repeat OSHA violation in the past three years may be disqualified.
The federal contract opportunity is for construction of a new Central Utility Plant at the Dallas VA Medical Center. The pre-proposal site visit date originally scheduled for November 16, 2020 has been postponed, and the forthcoming solicitation number 36C10F-20-R-0091 will announce the new date. Interested contractors are to monitor the SAM.gov website for release of the solicitation and any additional special notices. The construction project is to be awarded on an unrestricted basis.
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Text version
OPTIONAL FORM FOR BIDDER/OFFEROR TO COMPLETE &
SUBMIT WITH BID/PROPOSAL
(FROM CFM WEBSITE)
Pre-Award Contractor Evaluation Form
Company Name: ______________________________________________
Address: _____________________________________________________
Telephone: ______________________ Fax: ________________________
Email: _______________________________________________________
Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 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. (Four serious, one repeat, or one willful disqualifies the contractor.)
Please attach all supporting documentation for EMR-EPA. 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 your six-digit North American Industrial Classification System (NAICS) Code for this acquisition: __________________________________
3. Who administers your company’s Safety and Health Program?
4. Company’s Insurance Experience Modification Rate (EMR) for the past 3 years (an EMR of greater than 1.0 disqualifies the contractor): _____________
As of 2/18/2012
File details come from the government source that posted it. Updated .