EMR 36C24823R0062.pdf
PDF 261 KB Posted
- Attached to
- Y1LZ--FY23: STATION (Proj: 673-20-109) D/B - Repair Expansion Joints in Building 55 Parking Garage
- Solicitation number
- 36C24823R0062
About this file
This document contains a pre-award safety questionnaire and related federal contract solicitation. The pre-award questionnaire requests safety-related information from prospective construction contractors, including OSHA recordable incident rates for the past three years, details of any OSHA or EPA violations, and experience modification rates. The related federal contract opportunity is a solicitation from the Department of Veterans Affairs for repair work to expansion joints in the parking garage at the James A. Haley VA Hospital. The project number is 673-20-109 and responses are due via solicitation number 36C24823R0062. This opportunity is being issued as a tiered small business set-aside with priority given to verified SDVOSB, VOSB, HUBZone, and 8(a) firms. The point of contact for the solicitation is the contracting officer.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 36C24823R0062 0001.docx | DOCX document | |
| Past Performance Questionnaire.pdf | ||
| VA Tampa B55 Structural Assessment Report 2022-02-07 FINAL.pdf | ||
| Building 55 - Facade Report.pdf | ||
| Price Matrix.xlsx | XLSX spreadsheet | |
| INSTRUCTIONS TO OFFERORS AND EVALUATION INFORMATION 12 Dec 2022.pdf | ||
| 36C24823R0062 Dec 12 2022.pdf | ||
| Site Map and Drawings Prj 673-20-109.pdf | ||
| Building 55 - Structural Report.pdf | ||
| 673 20 109 SOW 25 Oct 2022.pdf | ||
| Davis Bacon Wage FL20220116 dtd 9 Sep 2022.txt | TXT text file | |
| TIL SPECS.pdf |
Show all 12
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
Attachment D
Safety or Environmental Violations and Experience Modification Rate
Pre-Award Contractor Safety and Environmental Record Form
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 or any EPA violations 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. Who administers your company’s Safety and Health Program?
3. Company’s Insurance Experience Modification Rate (EMR) for the past 3 years (an EMR of 1 or less is required): _____________
Please see FOPR 36C24823R0062 http://www.osha.gov/pls/publications/publication.html
| Solicitation Attachment |
| Safety or Environmental Violations and Experience Modification Rate |
| Solicitation Attachment |
| Safety or Environmental Violations and Experience Modification Rate |
File details come from the government source that posted it. Updated .