J.06 Attachment 06 - EMR [1 Page].pdf
PDF 77 KB Posted
- Attached to
- Y1DA--(PROJ: 573A4-21-816) DB - Replace Cooling Towers Federal contract opportunity
- Solicitation number
- 36C24822R0107
About this file
This document contains an EMR form for bidders to complete and submit with proposals for a federal contract opportunity to replace cooling towers. The form requests the bidder's company name and contact information as well as OSHA recordable incident rates for the past three years, including total hours worked, number of cases involving days away from work or job transfer/restriction, and days away from work rate. It also requests the bidder's six-digit NAICS code and administrator of its safety and health program. Bidders must attach OSHA forms 300 and 300A and have an experience modification rate no greater than 1.0 for the past three years or they will be disqualified.
The related federal contract opportunity is to replace cooling towers with a project number of 573-a4-21-816 at the Department of Veterans Affairs. This is a set-aside for Service-Disabled Veteran-Owned Small Businesses. The phase one proposal due date is August 22, 2022 at 3:30 PM. The solicitation number is 36C24822R0107 and vendor verification for SDVOSBs can be found at a provided website.
View the file
Other files for this federal contract opportunity
Show all 14
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
EMR FORM FOR BIDDER/OFFEROR TO COMPLETE & SUBMIT WITH PROPOSAL
Pre-Award Contractor Evaluation Form Company Name:
Address: _____________________________________________________
Telephone: ______________________ Fax: ________________________
Email: _______________________________________________________
Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2018 2019 2020 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. Provide your six-digit North American Industrial Classification System (NAICS) Code for this acquisition: __________________________________
3. Who administers your company’s Safety and Health Program?
4. Company’s Insurance Experience Modification Rate (EMR) for the past 3 years (an EMR of greater than 1.0 disqualifies the contractor): _____________
File details come from the government source that posted it. Updated .