S02 Attachment B_Contractor Certification RE Safety and EMR.docx
DOCX document 15 KB Posted
- Attached to
- Z1DZ--570-19-701 | Construct Photovoltaic System
- Solicitation number
- 36C26123R0115
About this file
This document contains a contractor certification regarding safety and environmental records and experience modification rates (EMR) that must be submitted with bids or proposals for the federal contract opportunity numbered 36C26123R0115 to construct a photovoltaic system for the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21. To be eligible for consideration and award, contractors must have no more than three serious or one repeat or one willful OSHA or EPA violations within the past three years and have a current EMR of less than or equal to 1.0 as verified by their insurance carrier on carrier letterhead. Contractors must also submit a certification on company letterhead regarding their number of serious, willful or repeat OSHA and EPA violations in the past three years and sign and provide contact information for the certifying official.
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Other files
| File | Type | Posted |
|---|---|---|
| S02 Attachment A_Price Breakdown.xlsx | XLSX spreadsheet | |
| S02 - RFI Form - 36C26123R0115-2.docx | DOCX document | |
| 36C26123R0115_2.docx | DOCX document | |
| 570-19-701-TMM2115-100 Drawings-Full Set 3-31-23.pdf | ||
| 570-19-701-TMM2115-100_Specifications.pdf |
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ATTACHMENT B
CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL
Contractor Certification Regarding Project: 36C26123R0115-2 – Construct Photovoltaic System Design, Project # 570-19-701 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.)
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