PER VHA DIRECTIVE 7715.pdf

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Z1DA -- 654-23-011 Isolation Room Mitigation
Solicitation number
36C26123R0091
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This document outlines safety and environmental record requirements for a federal construction contract opportunity with the Department of Veterans Affairs. To be eligible for consideration, contractors must have no more than three serious, one repeat, or one willful OSHA or EPA violations in the past three years and an Experience Modification Rate (EMR) of 1.0 or below from their insurance carrier. Offerors must submit a self-certification of their safety and environmental record on company letterhead, as well as documentation of their current EMR signed by their insurance carrier. The contract opportunity is for isolation room mitigation at Veterans Integrated Service Network 21 and has a solicitation number of 36C26123R0091.

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PER VHA DIRECTIVE 7715 (06 April 2017) - SAFETY &

ENVIRONMENTAL RECORD AND EXPERIENCE MODIFICATION

RATE (EMR):

Contractor Certification Regarding Project:

To be eligible for consideration and award, the contractor shall have no more than three serious, or one repeat, or one willful OSHA or EPA violation(s) in the past 3 years and have an EMR of equal to or less than 1.0.

All Offerors shall submit the following information pertaining to their past Safety & Environmental Record and EMR with their offer.

1. SAFETY & ENVIRONMENTAL RECORD: A self-certification on company letterhead that the contractor has no more than three (3) serious, or one (1) repeat or one (1) willful OSHA or any EPA violation(s) in the past three years.

2. EMR: All Offerors shall submit information regarding their current EMR. This information shall be obtained from the Offeror’s insurance carrier and be furnished on the insurance carrier’s letterhead. If an Offeror’s EMR is above 1.0, Offeror shall submit a written explanation of the EMR from its insurance carrier furnished on the insurance carrier’s letterhead, describing the reasons for the EMR, and the anticipated date the EMR may be reduced to 1.0 or below.

2019 2020 2021 2022 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.)

Number of violations from EPA within the last 3 years. Please attach explanation for any violations.

Company’s Current Insurance Experience Modification Rate (EMR) =

(Note: Contractor must support the EMR with a signed letter from Insurance Carrier on their letterhead.)

Signature:

Print Name:

PER VHA DIRECTIVE 7715 (06 April 2017) - SAFETY & ENVIRONMENTAL RECORD AND EXPERIENCE MODIFICATION RATE (EMR):

File details come from the government source that posted it. Updated .