EMR 36C25024R0047.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C25024B0043
About this file
This document is a Pre-Award Contractor Safety and Environmental Record Evaluation Form related to Solicitation # 36C25024R0047. The form requests the contractor to provide information on their company's safety and environmental record, including OSHA 300 and 300A form data, DART rate, and details on any OSHA violations within the last 3 years. The contractor is also asked to provide their North American Industry Classification System (NAICS) code, the administrator of their safety and health program, and their Insurance Experience Modification Rate (EMR).
The related federal contract opportunity is Solicitation # 36C25024B0043 for Provide Asphalt Sealcoating and Line Striping - 610-24-508, issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10. The solicitation requires the contractor to provide all labor, equipment, materials, and supervision necessary to prep existing asphalt, repair cracks, remove old markings, and install asphalt sealcoating and line striping at various buildings and parking lots. The work must be completed after hours or on weekends in high-traffic areas. Only electronic bids are being accepted via email to the specified contracting officer.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25024B0043 0003.docx | DOCX document | |
| 36C25024B0043 0003.docx | DOCX document | |
| RFI 610-24-508 Additional 1.pdf | ||
| 36C25024B0043 0002.docx | DOCX document | |
| RFI 610-24-508.pdf | ||
| 610-24-508 Site Visit Attendance.pdf | ||
| 36C25024B0043 0001.docx | DOCX document | |
| IFB 36C25024B0043.pdf | ||
| IFB 36C25024B0043.pdf | ||
| VHA Directive 1192 01.pdf | ||
| Wage Determination - Indy - Jan 2024.pdf | ||
| 610-24-508 - Specifications.pdf | ||
| RFI Form 36C25024R0047.doc | DOC document | |
| Contractor Certification Regarding Safety and Environmental 610-24-508.docx | DOCX document | |
| 36C25024R0094 Synopsis 610-24-508 - Provide Asphalt Sealcoating and Line Striping.pdf | ||
| 610-24-508 - Drawings.pdf |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form Information provided below is current and applicable to Solicitation # 36C25024R0047.
Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2023 |
| 2022 |
| 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: __________________________________ |
| 3. | Who administers your company’s Safety and Health Program? ____________________________ |
| 4. | Company’s Insurance Experience Modification Rate (EMR): ____________________________ |
File details come from the government source that posted it. Updated .