S02 Attachment C_Contractor Certification RE Safety and EMR 654-21-104.docx
DOCX document 15 KB Posted
- Solicitation number
- 36C26122R0073
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26122R0073 0001.pdf | ||
| 36C26122R0073 Reroof Building 1A and 12.pdf | ||
| S02 Attachment B_Price Breakdown 654-21-104.xlsx | XLSX spreadsheet | |
| 654-21-104 (Replace Roofing 1A and 12) FINAL Plans.pdf | ||
| 654-21-104 (Replace Roofing 1A and 12) FINAL Specs.pdf | ||
| S02 - RFI Form - 36C26122R0073 654-21-104.docx | DOCX document |
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ATTACHMENT C
CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL
Contractor Certification Regarding Project: 36C26122R0073 - VA Reno - Reroof Bldgs 1A and 12, Project # 654-21-104 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 |
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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