S02 Attachment B_Contractor Certification RE Safety and EMR.docx
DOCX document 15 KB Posted
- Attached to
- Z2LZ--VISN 21 MACC Group 2 Project # 612A4-21-011 Correct Sacramento Entrance Access and Parking (VA Mather)
- Solicitation number
- 36C26124R0007
About this file
This document contains a contractor certification regarding safety and environmental records for a federal construction project. The solicitation seeks bids from contractors to correct entrance access and parking at the Sacramento VA Medical Center campus in Mather, California. To be eligible for award, contractors must self-certify that they have no more than three serious, one repeat, or one willful Occupational Safety and Health Administration or Environmental Protection Agency violations in the past three years. They must also have a current experience modification rate of 1.0 or less according to their insurance carrier. With their response, contractors must provide documentation of their safety and environmental record from the past three years as well as a letter from their insurance carrier verifying their current experience modification rate. The solicitation is issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26124R0007 0004.docx | DOCX document | |
| 36C26124R0007 0003.docx | DOCX document | |
| 210416_AGI Geotech_MatherB650.pdf | ||
| 36C26124R0007 0002.docx | DOCX document | |
| 36C26124R0007 0001.docx | DOCX document | |
| S04 - Completed Site Visit Log Form - 612A4-21-011.pdf | ||
| 852.219-75 - VA Notice of Limitations on Subcontracting--Certificate of Compliance for SErvices and Construction - JAN 2023 Deviation.docx | DOCX document | |
| S02 - Specifications - 000000 to 024100.pdf | ||
| 36C26124R0007.docx | DOCX document | |
| S02 - Specifications - 033000 to 347113.pdf | ||
| S02 - Drawings_Combined_612A4_21_011_FULL_SIZE_FINAL_230804.pdf | ||
| S02 - RFI Form - 36C26124R0007.docx | DOCX document | |
| S02 - VA Mather Site Map 2023- parking options for guests.pdf | ||
| S02 Attachment A_Price Breakdown.xlsx | XLSX spreadsheet |
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Text version
ATTACHMENT B
CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL
Contractor Certification Regarding Project: 36C26124R0007 – Correct Mather Entrance Access and Parking, Project # 612A4-21-011 PER VHA DIRECTIVE 7715 (06 April 2017): SAFETY & ENVIRONMENTAL RECORD AND EXPERIENCE MODIFICATION RATE (EMR): To be eligible for consideration and award, the contractor shall have no more than three serious, or one repeat, or one willful OSHA or EPA violation(s) within the past 3 years and have an EMR of equal to or less than 1.0.
All Offerors shall submit the following information pertaining to their past Safety & Environmental Record and EMR with their bid/proposal:
SAFETY & ENVIRONMENTAL RECORD: A self-certification on company letterhead that the Offeror has no more than three (3) serious, or one (1) repeat or one (1) willful OSHA or any EPA violation(s) within the past three years. Include the following table and signature block.
| 2020 |
| 2021 |
| 2022 |
| 2023 |
Number of serious, willful, or repeat violations from OSHA within the last 3 years.
Number of serious, willful, or repeat violations from EPA within the last 3 years
Signature: ______________________________________________ Typed Name: ______________________________________________________ Title: ______________________________________________________
EMR: All Offerors shall submit information regarding their current EMR. This information shall be obtained from the Offeror’s insurance carrier and be furnished on the insurance carrier’s letterhead.
Contractor’s Current Insurance Experience Modification Rate (EMR) = _____________ (Note: Contractor must support the EMR with a signed letter from Insurance Carrier on their letterhead.)
File details come from the government source that posted it. Updated .