EXHIBIT C CONTRACTOR EVALUATION FORM CONSTRUCTION SAFETY v2.docx
DOCX document 27 KB Posted
- Solicitation number
- 36C25621R0145
About this file
This solicitation is for a construction project to develop private and semi-private bed spaces at a Veterans hospital. The project has an anticipated construction cost range of $5 million to $10 million. It will be issued as a 100% set-aside for Service-Disabled Veteran-Owned Small Businesses. The solicitation is expected to be released on or around August 1, 2021, with proposals due approximately 30 days later on September 1, 2021. The contract award is anticipated within 30 days of proposal receipt. The recommended period of performance is 485 calendar days from notice to proceed. The work location is the John L. McClellan Veterans Memorial Hospital in Little Rock, Arkansas. Offerors are asked to review all RFP documents and attachments before submitting any questions by the established cut-off date. Only one site visit will be conducted, with no additional or make-up visits permitted.
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Text version
FOR OFFICIAL USE ONLY
Exhibit C Contractor Evaluation Form Construction Safety
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 explanations 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 current Insurance Experience Modification Rate (EMR): |
The above EMR rate must be obtained from offeror’s insurance carrier and furnished on insurance carrier’s letterhead. If EMR is greater than 1.0, attach a written explanation of the EMR from insurance carrier on insurance carrier’s letterhead describing the reasons for the EMR and the anticipated date the EMR may be reduced to 1.0 or below.
File details come from the government source that posted it. Updated .