S02_Attachment 07 Safety or Environmental Violations and EMR Information.pdf
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- Solicitation number
- 36C26326R0038
About this file
This file contains requirements for contractor responsibility determination and an evaluation form related to safety and environmental records for federal contract solicitation 36C26325R0017.
Bidders and offerors must submit comprehensive information about their past safety and environmental compliance records. The submission must certify that the bidder has no more than three serious violations, one repeat violation, or one willful OSHA or EPA violation within the past three years; if this certification cannot be made, detailed explanations and circumstances must be provided. All bidders must submit current Experience Modification Rate (EMR) information obtained from their insurance carrier on letterhead. If the EMR exceeds 1.0, bidders must provide a written explanation from the insurance carrier detailing 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 state-run workers' compensation insurance rating bureaus for CA, DE, MI, NJ, ND, OH, PA, WA, WY, and PR. If NCCI cannot issue an EMR due to lack of insurance history, bidders must submit letters from both the insurance carrier and NCCI indicating a Unity Rating of 1.0. The government will use submitted information along with OSHA and EPA online inspection history databases to make an initial responsibility determination. This requirement applies to all subcontracting tiers, and prospective prime contractors are responsible for determining the responsibility of their prospective subcontractors. The evaluation form requires submission of OSHA 300 and 300a forms, man hours data, injury and illness statistics, DART rates, and OSHA violation information for years 2021 through 2024, with the NAICS code identified as 236220.
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PRIME CONTRACTOR INFORMATION REQUIRED TO PERFORM A
DETERMINATION OF RESPONSIBILITY
Safety or Environmental Violations and Experience Modification Rating Information
1. 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.
2. 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 elevated EMR and the anticipated date the EMR may be reduced to 1.0 or below.
3. 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.
4. 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.
5. 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.
6. This requirement is applicable to all subcontracting tiers, and prospective prime contractors are responsible for determining the responsibility of their prospective subcontractors.
PRE-AWARD CONTRACTOR SAFETY AND ENVIRONMENTAL RECORD
EVALUATION FORM
Information provided below is current and applicable to Solicitation: 36C26325R0017 Company Name: ___________________________________________________________ Address:
Telephone: Fax:
Email:
Contact:
Utilizing the completed OSHA 300 Forms, please complete the table below:
Category 2021 2022 2023 2024 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 (Log of Work-Related Injuries and Illnesses) and 300a Forms (Summary of Work-Related Injuries and Illnesses).
These forms can be accessed through the OSHA publications search page: http://www.osha.gov/pls/publications/publication.html.
1. Provide six-digit North American Industrial Classification System (NAICS) Code for this acquisition: 236220
2. Who administers your company’s Safety and Health Program?
3. Company’s Insurance Experience Modification Rate (EMR):
http://www.osha.gov/pls/publications/publication.html
| PRIME CONTRACTOR INFORMATION REQUIRED TO PERFORM A DETERMINATION OF RESPONSIBILITY |
| PRE-AWARD CONTRACTOR SAFETY AND ENVIRONMENTAL RECORD EVALUATION FORM |
File details come from the government source that posted it. Updated .