S02 - Attach 4 - EMR.docx
DOCX document 16 KB Posted
- Attached to
- Replace Electrical Panel Board in OR Federal contract opportunity
- Solicitation number
- 36C24823R0073
About this file
This document contains a pre-award contractor evaluation form and details for a federal contract opportunity to replace electrical panel boards in operating rooms at the Miami VA Medical Center. The pre-award form requests company information including number of man hours, OSHA recordable cases, DART rates for the past three years, NAICS code, safety program administrator, and experience modification rates. Bidders must attach OSHA forms and have an EMR of less than 1.0. The federal contract opportunity is to replace standard ground panel boards with isolated power systems and provide redundant power sources from two critical branch circuits in each operating room. A site visit is scheduled for January 10th, 2023 and price proposals are due February 3rd, 2023. The work must be completed while maintaining operating room usage. The Department of Veterans Affairs VISN 8 is the contracting agency.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amendment 0001 - 36C24823R0073.docx | DOCX document | |
| S02 - Attach 9 Set of Drawings 2 of 4.pdf | ||
| S02 - SOLICITATION 36C24823R0073.pdf | ||
| S02 - Attach 7 Price Matrix.xlsx | XLSX spreadsheet | |
| S02 - Attach 11 Set of Drawings 4 of 4.pdf | ||
| S02 - Attach 13 Narrative Set 2 of 3.pdf | ||
| S02 - Attach 5 Past Performance Form.pdf | ||
| S02 - Attach 14 Narrative Set 3 of 3.pdf | ||
| S02 - Attach 1 Site Plan.pdf | ||
| S02 - Attach 12 Narrative Set 1 of 3.pdf | ||
| S02 - Attach 2 _ Wage Dtermination FL20220125 _9_29_22.pdf | ||
| S02 - Attach 8 Set of Drawings 1 of 4.pdf | ||
| S02 - Attach 10 Set of Drawings 3 of 4.pdf | ||
| S02 - Attach 15 Floor Plan.pdf | ||
| S02 - Attach 3 Limitations of Subcontracting .pdf | ||
| S02 - Attach 6 Experience Information Sheet.docx | DOCX document |
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Text version
EMR FORM FOR BIDDER/OFFEROR TO COMPLETE & SUBMIT WITH PROPOSAL Attach 4 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 .