Experience Modification Rate EMR Insurance Contractor Certification Solicitation 12405B24R0003.docx

This document is a certification form for contractors bidding on Solicitation 12405B24R0003 from the Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery to replace an existing Photo Period Building. The form requires contractors to disclose the number of serious, willful, or repeat 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. Additionally, contractors must disclose their current Experience Modification Rate as issued by their insurance carrier and provide a signed letter from the carrier on letterhead supporting the stated EMR. By signing the form, contractors certify the accuracy of the violation and EMR disclosures. The related solicitation is for the replacement of the Photo Period Building in accordance with the attached Statement of Work and has a solicitation number of 12405B24R0003.