EMR 36C25024R0095.docx
DOCX document 14 KB Posted
- Attached to
- Install Isolation Filter System 610-24-509
- Solicitation number
- 36C25024B0044
About this file
The document is a Pre-Award Contractor Safety and Environmental Record Evaluation Form for Solicitation # 36C25024R0095. The form requires the contractor to provide information on their OSHA safety record, including number of man hours, number of cases involving days away from work, their DART rate, and any OSHA violations in the last 3 years. The contractor must also provide their 6-digit NAICS code, who administers their safety program, and their insurance Experience Modification Rate (EMR).
The related federal contract opportunity is Solicitation # 36C25024B0044 to Install Isolation Filter System 610-24-509. The contractor will provide all labor, equipment, materials and supervision necessary to install 34 VA-provided negative/positive pressure isolation units with UV function, Accustat, and EchoPhan blower module in Building 172 at the VA Northern Indiana Health Care - Marion Campus. The work must be completed within 120 calendar days of the notice to proceed. Only electronic bids are being accepted via email to the Contracting Officer.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25024B0044 Bid Opening Call in Information 0003.docx | DOCX document | |
| 36C25024B0044 0002.docx | DOCX document | |
| RFI part 1.docx | DOCX document | |
| 610-24-509 Site Visit Attendance.pdf | ||
| 36C25024B0044 0001.docx | DOCX document | |
| 610-24-509 - Complete Drawings.pdf | ||
| RFI Form 36C25024B0044.doc | DOC document | |
| Contractor Certification Regarding Safety and Environmental 610-24-509.docx | DOCX document | |
| 610-24-509 - Specifications.pdf | ||
| VHA Directive 1192 01.pdf | ||
| IFB 36C25024B0044.pdf | ||
| RFI Form 36C25024R0095.doc | DOC document | |
| 610-24-509 - SOW.doc | DOC document | |
| IN 2024 Wage Determination.txt | TXT text file |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form Information provided below is current and applicable to Solicitation # 36C25024R0095.
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 .