S02 - Attachment 03 - Contractor Safety and EMR - 2 Pages - BB 672-26-110.docx
DOCX document 21 KB Posted
- Attached to
- Z2DA--Repair Water Tanks Deficiencies
- Solicitation number
- 36C24826R0075
About this file
This is a contractor qualification attachment requiring submission of safety and environmental compliance documentation as part of the bidding process for a Department of Veterans Affairs water tank repair project in San Juan, Puerto Rico.
All bidders must certify they have no more than three serious violations, one repeat violation, or one willful OSHA or EPA violation within the past three years, or provide detailed explanations if this standard cannot be met. Bidders must submit their current Experience Modification Rate (EMR) from their insurance carrier on letterhead; if the EMR exceeds 1.0, the contractor must provide a written explanation from the insurance carrier describing reasons for the elevated rate and the anticipated timeline for reduction to 1.0 or below. Self-insured contractors or those unable to obtain EMR ratings from their insurance carrier must obtain ratings from the National Council on Compensation Insurance (NCCI) using form ERM-6, or from their state's workers' compensation insurance rating bureau if located in California, Delaware, Michigan, New Jersey, North Dakota, Ohio, Pennsylvania, Washington, Wyoming, or Puerto Rico. Contractors lacking insurance history must submit a letter from their insurance carrier and documentation from NCCI confirming a Unity Rating of 1.0. Bidders must complete a Pre-Award Contractor Safety and Environmental Record Evaluation Form providing three years of OSHA 300 form data, including man hours, DART rates, and details on serious, willful, or repeat violations; identification of the company's safety program administrator; and their six-digit NAICS code. This requirement applies to all subcontracting tiers, with prime contractors responsible for verifying subcontractor responsibility.
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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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