EXHIBIT C.docx

This is a Contractor Evaluation Form for construction safety associated with a roof replacement project at the Department of Veterans Affairs, Veterans Health Administration, Veterans Integrated Service Network 16 (VISN 16). The solicitation number is 36C25626R0020, and the project involves replacing the roof on the Emergency Generator Building 39.

The evaluation form requires contractors to submit detailed safety documentation and metrics across three years (2022, 2023, 2024), including total man hours worked at jobsites and offices, the number of cases involving days away from work or restricted activity, calculation of the DART rate (Days Away, Restricted, or Transferred), and documentation of serious, willful, or repeat OSHA violations. Contractors must provide copies of their OSHA 300 and 300A Forms and identify the individual or department administering the company's Safety and Health Program. Additionally, contractors must submit their current Insurance Experience Modification Rate (EMR) on their insurance carrier's letterhead; if the EMR exceeds 1.0, they must provide a written explanation from the insurance carrier detailing the reasons for the elevated rate and the anticipated timeline for reduction to 1.0 or below. This form serves as part of the contractor selection criteria and requires submission of supporting documentation to demonstrate safety performance and compliance history.