S02 - Attachment 09 - Experience Modification Rate (EMR) (1 page).docx
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- Attached to
- Y1NB--Replace Air Handling Unit No. 2 and 3 Federal contract opportunity
- Solicitation number
- 36C24822R0103
About this file
This document contains statements of work for a federal construction contract opportunity to replace air handling units at the Malcom Randall VA Medical Center in Gainesville, Florida. The project involves replacing two air handling units, AHU-2 and AHU-3, which will require demolishing and replacing ceiling systems to allow for new mechanical distribution ductwork. Replacing AHU-2 has a performance period of 1,095 calendar days, while replacing AHU-3 is 730 calendar days. The work includes installing new air handling equipment, fans, ductwork, VAV boxes, controls integration, and temporary swing space for relocated occupants. Electrical work encompasses feeders, branch circuits, fire alarms and lighting to support the new mechanical systems. The statements of work provide construction requirements and specifications according to VA standards and applicable building codes.
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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 .