Experience Modification Rate Form 2022 Revised 2 2 2023.pdf
PDF 160 KB Posted
- Attached to
- Z1DA--Project 557-22-901 Replace and Upgrade Building 5 Generator Federal contract opportunity
- Solicitation number
- 36C24724R0081
About this file
This document is an Experience Modification Rate (EMR) Form that must be completed and submitted by offerors in response to Solicitation 36C24724R0081 for Project 557-22-901 to replace and upgrade the generator for Building 5 at the Dublin VA Medical Center.
The key details are:
- This is a 100% set-aside for Certified Service-Disabled Veteran-Owned Small Businesses (SDVOSBs). SDVOSBs must be certified and listed in the SBA certification database and registered in SAM.
- The project is a Firm Fixed Price construction contract with a magnitude between $1 million and $5 million, and an estimated 540-day completion period.
- The contractor must provide the number of man-hours, OSHA 300/300A data, and EMR rates for the past 3 years. Serious, willful, or repeat OSHA violations within the last 3 years may disqualify the contractor.
- The EMR information, along with other government data, will be used to ensure the contractor meets the Experience Modification Rate specified in the solicitation.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 557-22-901 Pre-Bid Sign-In Sheet.pdf | ||
| 557-22-901 Specs.pdf | ||
| 36C24724R0081 0001.docx | DOCX document | |
| RFIs 557-22-901 Bldg. 5 Generators_.docx | DOCX document | |
| Carl Vinson VAMC Map.pdf | ||
| Price Schedule Breakdown.xlsx | XLSX spreadsheet | |
| Contractor Experience Form.pdf | ||
| 852.219-75 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING Jan 2023 Dev form.pdf | ||
| 557 22 901 Drawings.pdf | ||
| GA20240095 Jan 05 2024.docx | DOCX document | |
| Combined Spec rev1.docx | DOCX document | |
| 36C24724R0081_1.docx | DOCX document |
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Text version
Attachment 1 Experience Modification Rate Form
Offeror To Complete & return with response to solicitation
Company Name: ______________________________________________________________________
Address: _____________________________________________________________________________
Telephone: _______________________ Email: _____________________________________________
Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2020 2021 2022 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 explanation for any violations. (Four serious, one repeat, or one willful disqualifies the contractor.)
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. Company’s Insurance Experience Modification Rate (EMR) for the past 3 years :
The above information, along with other information obtained from Government systems, such as the OSHA and EPA online inspection history databases will be used to ensure the contractor meets Experience Modification Rate indicated in the solicitation.
http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .