S02 - Attachment 03 - Safety or Environmental Violations and Experience Modification Rate EMR Form (1 page).pdf

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Attached to
Z2DA--Replace Motor Control Center at OPA Basement and Main Building Sub-basement Area
Solicitation number
36C24821R0123
Issued by

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This solicitation notice describes a design-build contract opportunity with the Department of Veterans Affairs to replace motor control centers at two facilities. The VA Caribbean Healthcare System seeks to award a firm-fixed-price contract between $2-5 million to provide all labor, materials, equipment, and design services necessary to replace six aging motor control centers exceeding 40 years old at the OPA Basement and Main Building Sub-Basement Area. Interested firms must be registered in SAM.gov and verified as service-disabled veteran-owned in VIP database by the July 19, 2021 closing date. The scope involves installing new MCCs minimum 800 amp capacity, feeders, conduits, lighting, and designing and constructing an equipment lift. The contractor will disconnect and dispose of existing equipment and provide all testing, project management, and permits.

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Other files

File Type Posted
36C24821R0123 0001 (incorporate Attachment 11).docx DOCX document
Attachment 11 - Mandatory Certification Limitations on Subcontracting (LOS) (1 page).pdf PDF
S02 - Attachment 07 - Letter of Commitment for Design Firm Teaming Arrangement (1 page).pdf PDF
S02 - Attachment 04 - Specialized Experience Form (3 pages).pdf PDF
S02 - Attachment 06 - Letter of Commitment for Key Personnel (1 page).pdf PDF
S02 - Attachment 09 - Itemized Cost Breakdown (1 page).xlsx XLSX spreadsheet
36C24821R0123 (DB 672-20-600).docx DOCX document
S02 - Attachment 02 - Specifications (80 pages).zip ZIP file
S02 - Attachment 08 - Subcontractor Past Performance Consent Form (1 page).pdf PDF
S02 - Attachment 10 - Past Performance Questionnaire (4 pages).pdf PDF
S02 - Attachment 11 - Key Personnel Resume Form (1 page).pdf PDF
S02 - Attachment 01 - Infection Control Guidelines on Construction and Renovation 11B-17-05 (11 pages).pdf PDF
S02 - Attachment 05 - Letter of Commitment Key Subcontractors (1 page).pdf PDF
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Solicitation Attachment

Safety or Environmental Violations and Experience Modification Rate

Pre-Award Contractor Safety and Environmental Record Evaluation Form

Company Name: ______________________________________________

Address: _____________________________________________________

Telephone: ______________________ Fax: ________________________

Email: _______________________________________________________

Contact: ______________________________________________________

1. Utilizing your OSHA 300 Forms, please complete the following information:

Category 2018 2019 2020

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): _____________ http://www.osha.gov/pls/publications/publication.html

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