J.07 Attachment 07 – Experience Modification Rate (EMR) [1 Page].docx
DOCX document 14 KB Posted
- Attached to
- (PROJ: 573-19-616) BB Correct Electrical Deficiencies (3-Year Test) Federal contract opportunity
- Solicitation number
- 36C24823R0042
About this file
This document contains a pre-award contractor evaluation form and details of a federal contract opportunity for electrical deficiency corrections. The pre-award form requests information on the bidder's experience modification rate, OSHA recordable incident rates for the past three years, NAICS code, and safety program administration. Bidders are required to provide documentation including OSHA 300 forms and must have an experience modification rate of 1.0 or below to qualify.
The related federal contract opportunity is to correct electrical deficiencies at a Veterans Affairs medical facility over three years. Proposals are due on November 28, 2022. The pre-solicitation notice provides contact information for a mandatory site visit scheduled on November 9, 2022 to review the scope of work. The work involves the Veterans Health Administration within Veterans Integrated Service Network 8.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| J.02 Attachment 02 - Drawing [99 Pages].pdf | ||
| J.03 Attachment 03 - Specifications [23 Pages].pdf | ||
| J.11 Attachment 11 – Subcontractor Past Performance Consent Form [1 Page].pdf | ||
| J.06 Attachment 06 – Price Matrix [1 Page].xlsx | XLSX spreadsheet | |
| J.05 Attachment 05 - VHA Supplemental Contract Requirements for Combatting COVID-19 [1 Page].pdf | ||
| J.10 Attachment 10 – Letter of Commitment Key Subcontractors [1 Page].pdf | ||
| J.01 Attachment 01 - Statement of Work [11 Pages].docx | DOCX document | |
| S02 - SF1449 - SOLICITATION - 36C24822R0167.pdf | ||
| J.08 Attachment 08 - Past Performance Questionnaire [5 Pages].docx | DOCX document | |
| J.09 Attachment 09 – Past Performance Survey [3 Pages].pdf | ||
| J.04 Attachment 04 - Wage Determination [5 Pages].pdf |
Show all 11
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Text version
EMR FORM FOR BIDDER/OFFEROR TO COMPLETE & SUBMIT WITH PRICE 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 |
| 2019 |
| 2020 |
| 2021 |
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 .