EXHIBIT D.docx
DOCX document 29 KB Posted
- Attached to
- 667-24-255 Bldg. 55 Accessibility Ramp Federal contract opportunity
- Solicitation number
- 36C25625R0125
About this file
This is a contractor evaluation form (Exhibit D) focused on construction safety requirements for federal contractors bidding on the Building 55 Accessibility Ramp project. The form requires contractors to provide comprehensive safety performance data including OSHA 300 Forms for 2022-2024, detailing man hours worked, workplace injury cases, Days Away Restricted or Transferred (DART) rates, and any serious OSHA violations within the past three years with accompanying explanations.
The evaluation form mandates disclosure of the company's Safety and Health Program administrator and requires the current Experience Modification Rate (EMR) from the contractor's insurance carrier on official letterhead. If the EMR exceeds 1.0, contractors must provide a written explanation from their insurance carrier describing the reasons and anticipated timeline for reduction to 1.0 or below. This safety evaluation appears to be part of the Department of Veterans Affairs solicitation 36C25625R0125 for the Building 55 Accessibility Ramp project, which is designated as a Veteran-Owned Small Business (VOSB) set-aside under the Veterans Health Administration.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25625R0125_1 08-06-2025.docx | DOCX document | |
| EXHIBIT A.docx | DOCX document | |
| EXHIBIT F.docx | DOCX document | |
| EXHIBIT B.docx | DOCX document | |
| EXHIBIT E.docx | DOCX document | |
| EXHIBIT C.docx | DOCX document | |
| S02 2016-03-21 Utilities Drawing.pdf | ||
| S02 Wage Determination 667-24-255 -01-03-2025.pdf | ||
| S02 SOW 10-03-2024.pdf | ||
| S02 B55 Ramp-Existing Drawing.pdf |
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 667-24-255 Bldg. 55 Accessibility Ramp 36C25625R0002
Exhibit D Contractor Evaluation Form Construction Safety
Company Name:
Address:
Telephone: Fax:
Email:
Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2022 |
| 2023 |
| 2024 |
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 .