S02 - Attachment 03 - Contractor Safety and EMR - 2 Pages - BB 672-19-709.docx
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- Attached to
- Z2DA--Upgrade Video Assessment Surveillance System Federal contract opportunity
- Solicitation number
- 36C24826R0064
About this file
This is a solicitation attachment requiring all bidders and offerors to submit documentation of their safety and environmental records for evaluation as part of the responsibility determination process for a VA construction project to upgrade a Video Assessment Surveillance System at the VA Caribbean Healthcare System in San Juan, Puerto Rico. Contractors must certify they have no more than three serious, one repeat, or one willful OSHA or EPA violation(s) within the past three years, or provide detailed explanations and circumstances if this certification cannot be made. Additionally, all bidders must submit their current Experience Modification Rate (EMR) obtained from their insurance carrier on carrier letterhead; if the EMR exceeds 1.0, contractors must provide a written explanation from the insurance carrier describing reasons for the elevated rate and the anticipated date for reduction to 1.0 or below. Self-insured contractors or those unable to provide EMR on insurance letterhead must obtain ratings from the National Council on Compensation Insurance, Inc. (NCCI) using form ERM-6, or from their respective state worker's compensation insurance rating bureaus for certain states (CA, DE, MI, NJ, ND, OH, PA, WA, WY, and PR).
The attachment includes a Pre-Award Contractor Safety and Environmental Record Evaluation Form requiring submission of OSHA 300 and 300a forms, man-hour data, days away and restricted activity rates (DART rates), NAICS codes, safety program administrator information, and EMR documentation for the past three years. This requirement applies to all subcontracting tiers, with prime contractors responsible for verifying subcontractor responsibility. The Government will use submitted information along with data from OSHA and EPA online inspection history databases to conduct the initial responsibility determination.
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Solicitation Attachment 03 Safety or Environmental Violations and Experience Modification Rate (EMR)
All Bidders/Offerors shall submit information pertaining to their past Safety and Environmental record. The information must contain a certification that the bidder/offeror 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. If such certification cannot be made, a Bidder/Offeror shall explain why and submit as much information as possible regarding the circumstances of its past safety and environmental record, including the number of EPA violations and/or the number of serious, repeat, and/or willful OSHA violations, along with a detailed description of those violations.
All Bidders/Offerors shall submit information regarding their current Experience Modification Rate (EMR). This information shall be obtained from the Bidder’s/Offeror’s insurance carrier and be furnished on the insurance carrier’s letterhead. If a Bidder/Offeror’s EMR is above 1.0, Bidder/Offeror must 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.
Self-insured contractors or other contractors that cannot provide their EMR rating on insurance letterhead must obtain a rating from the National Council on Compensation Insurance, Inc. (NCCI) by completing/submitting form ERM-6 and providing the rating on letterhead from NCCI. Note: Self-insured contractors or other contractors that cannot provide EMR rating on insurance letterhead from the states or territories of CA, DE, MI, NJ, ND, OH, PA, WA, WY, and PR shall obtain their EMR rating from their state run worker’s compensation insurance rating bureau.
If the NCCI cannot issue an EMR because the Bidder/Offeror lacks insurance history, Bidder/Offeror shall submit a letter indicating so from its insurance carrier furnished on the insurance carrier’s letterhead, and include a letter from the NCCI indicating that is has assigned Bidder/Offeror a Unity Rating of 1.0.
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 make an initial Determination of Responsibility.
This requirement is applicable to all subcontracting tiers, and prospective prime contractors are responsible for determining the responsibility of their prospective subcontractors.
Solicitation Attachment 03 Safety or Environmental Violations and Experience Modification Rate
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Email: _______________________________________________________ Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2023 |
| 2024 |
| 2025 |
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.
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): _____________ |
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