EMR.pdf
PDF 79 KB Posted
- Solicitation number
- 36C24921B0011
About this file
This document contains a pre-award contractor safety evaluation form and information on a related federal contract opportunity. The pre-award form requests contractor safety information including OSHA 300 and 300a forms from the past three years detailing man hours, injury cases, and violation details. It also requests the NAICS code and safety program administrator. The federal contract opportunity is a solicitation to replace a 750KW emergency generator at the James H. Quillen VA Medical Center. The 100% SDVOSB set-aside opportunity has an estimated value between $500,000 to $1,000,000. The NAICS code is 238210 and responses are due by July 28, 2021. The awarded contractor must be listed on beta.SAM.gov and VETS4212.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24921B0011 0002.pdf | ||
| 36C24921B0011 0001.docx | DOCX document | |
| Building 116 Lead and Asbestos Survey Results.pdf | ||
| RFI Form - 750kW Emergency Gen.pdf | ||
| Drawings 11-17.pdf | ||
| Drawings 24-33.pdf | ||
| Specs 621-19-123 Replace Emerg Generator Bldg 116 - Bid Documents .pdf | ||
| WD TN20210111 dated 1-1-2021.pdf | ||
| Drawings 18-23.pdf | ||
| Header - List of Attachments.txt | TXT text file | |
| 36C24921B0011_1.docx | DOCX document | |
| Drawings 1-10.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 36C24921B0011
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: __________________________________
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 .