S02 - Attachment 07 - Experience Modification Rate (EMR) (1 page).docx
DOCX document 14 KB Posted
- Attached to
- J061--Upgrade Motor Control Centers at BLDG One
- Solicitation number
- 36C24822R0166
About this file
This document contains a pre-award contractor evaluation form and instructions for a federal construction project to upgrade motor control centers at a Department of Veterans Affairs medical center. The form requests contact information and the following data from bidders/offerors for the past three years: number of man hours, OSHA recordable cases, days away from work or job transfer rate, serious violations, and experience modification rate (EMR). Bidders must attach OSHA forms and provide their NAICS code and safety program administrator. An EMR over 1.0 or serious, willful, or repeat OSHA violations in the past three years will disqualify the contractor from consideration.
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Text version
EMR FORM FOR BIDDER/OFFEROR TO COMPLETE & SUBMIT WITH PRICE PROPOSAL
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 .