S02 Attachment 10_EMR_1 Page.pdf

This is a Pre-Award Contractor Evaluation Form used to assess bidders' safety and health compliance prior to contract award.

Bidders must complete the form with company information including name, address, telephone, fax, email, and primary contact. The form requires submission of OSHA 300 and 300a forms documenting occupational safety and health data for the years 2022 through 2025, specifically: total man hours worked at jobsites and offices; number of cases involving days away from work, restricted activity, or both; days away, restricted, or transferred rate (DART Rate) calculated as the number of such cases multiplied by 200,000 divided by total man hours; and the number of serious, willful, or repeat OSHA violations within the past three years with required explanations. Bidders must provide their six-digit North American Industrial Classification System (NAICS) code for the acquisition and identify the individual or department administering their company's Safety and Health Program. The form includes a disqualification criterion: contractors with an Insurance Experience Modification Rate (EMR) greater than 1.0 for the past three years are disqualified from award. Similarly, contractors with four or more serious violations, one repeat violation, or one willful violation within the past three years are disqualified. This template form requires completion and submission with all proposals.