Experience Modification Rate EMR Insurance Contractor Certification Solicitation 12405B23Q0476.docx

This document is a certification form for contractors bidding on Solicitation 12405B23Q0476 from the Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery to relocate two backflow preventers. The form requires bidders to disclose the number of OSHA violations in the last four years and provide an explanation for any violations, as three serious, one repeat, or one willful violation would result in being deemed non-responsible. Bidders must also disclose their current insurance Experience Modification Rate and provide a signed letter from their insurance carrier on letterhead supporting the stated EMR. By signing the form, bidders certify this information is correct before the agency will consider their bid for the solicitation to relocate two backflow preventers.