S02 Attachment C_Contractor Certification RE Safety and EMR.docx
DOCX document 15 KB Posted
- Solicitation number
- 36C26122R0083
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26122R0083 0003.pdf | ||
| 36C26122R0083 0002.pdf | ||
| SITE VISIT LOG 36C26122R0083.pdf | ||
| 36C26122R0083 0001.pdf | ||
| Exhibit4_640-14-123P_SCI Refresh_STRUCTUALCALC.pdf | ||
| Exhibit1_640-14-123P_SCI Refresh_DRAWINGS.pdf | ||
| S02 - RFI Form - 36C26122R0083.docx | DOCX document | |
| Exhibit 3 ICRA Form.pdf | ||
| 36C26122R0083.pdf | ||
| S02 Attachment B_Price Breakdown.xlsx | XLSX spreadsheet | |
| Exhibit2_640-14-123P_SCI Refresh_SPECS.pdf |
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ATTACHMENT C
CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL
Contractor Certification Regarding Project: 36C26122R0083 - VAPAHCS - Renovate Building 7 for Spinal Cord Injury Unit, Project # 640-14-123P 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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