S02 - Attachment 4 - EMR (1 Page).docx

DOCX document 16 KB Posted

Attached to
Address Roofs at Orlando Campuses, Orlando FL
Solicitation number
36C24823R0002
Issued by

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This document contains a pre-award contractor evaluation form and details of a federal contract opportunity for roof repairs at Orlando campuses. The form requests company information including NAICS code, OSHA recordable incident rates for the past three years, safety program administration, and experience modification rates. Bidders must have an EMR of 1.0 or less. The solicitation is for trade-off best value evaluation to repair roofs at Orlando VA campuses. Phase one proposals are due November 10th with RFIS by October 31st. This is a two-phase design/build set-aside for VIP certified SDVOSB. The contracting agency is the Department of Veterans Affairs VISN 8.

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Other files

File Type Posted
S02 - Attachment 3 - Specilialized Experience Form.pdf PDF
S02 - Attachment 1 - Wage Determination.pdf PDF
S02 - Attachment 5 - Limitations of Subcontracting.pdf PDF
S02 - Attachment 6 - Past Performance Forms.pdf PDF
S02 - SOLICITATION FOR 36C24823R0002 ROOF AT ORLANDO CAMPUSES 11_20_22.pdf PDF
S02 - Attachment 2 - Base Offer Breakdown.xlsx XLSX spreadsheet

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EMR FORM FOR BIDDER/OFFEROR TO COMPLETE & SUBMIT WITH PROPOSAL Attach 4 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 .