S02 - Attachment 07 - Experience Modification Rate (EMR) (1 page).docx
DOCX document 14 KB Posted
- Attached to
- J045--Replace Plumbing Systems in Bldg. 64 Federal contract opportunity
- Solicitation number
- 36C24822R0194
About this file
This document contains a pre-award contractor evaluation form and details for a federal contract opportunity to replace plumbing systems in Building 64 at the Lake City Veterans Affairs Medical Center in Lake City, Florida. The pre-award form requests information on the bidding contractor's experience modification rate, OSHA recordable incident rates for the past three years, NAICS code, and safety program administration. Contractors must have an experience modification rate of 1.0 or below to qualify. The replacement project will remove and replace overhead horizontal sanitary mains and branches in the basement ceiling space to address issues with the existing piping system. An organized site visit is scheduled for October 18, 2022 at 10:00 AM EST for potential bidders to meet at the visitors parking area of the medical center. The engineering office meeting location and other relevant details are provided.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C24822R0194 0001.docx | DOCX document | |
| S02 - Attachment 11 - Subcontractor Past Performance Consent Form (1 page).docx | DOCX document | |
| S02 - Attachment 10 - Letter of Commitment Key Subcontractors (1 page).pdf | ||
| S02 - Attachment 03 - VAAR 852.219-77 LOS Certification (2 pages).docx | DOCX document | |
| S02 - Attachment 01 - Drawings Replace Plumbing (68 pages).pdf | ||
| 36C24822R0194 (Replace Plumbing).docx | DOCX document | |
| S02 - Attachment 09 - Past Performance Survey (3 pages).docx | DOCX document | |
| S02 - Attachment 08 - Past Performance Questionnaire (3 pages).docx | DOCX document | |
| S02 - Attachment 06 - Price Matrix (1 page).xlsx | XLSX spreadsheet | |
| S02 - Attachment 05 Wage Determination.pdf | ||
| S02 - Attachment 04 - VHA Supplemental Contract Requirements for Combatting COVID-19 (2 pages).docx | DOCX document | |
| S02 - Attachment 02 - Specifications Replace Plumbing (360 pages).pdf |
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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 .