S02 ATTACHMENT C EMR (1 PAGE).docx
DOCX document 14 KB Posted
- Attached to
- Bid/Build Renovate Spinal Cord Unit Federal contract opportunity
- Solicitation number
- 36C24823R0107
About this file
This document contains a pre-award contractor evaluation form and details of a related federal contract opportunity for renovating the spinal cord unit at the Miami VA Medical Center. The pre-award form requests information on a contractor's OSHA 300 forms from 2019 to 2021 including man hours, days away from work cases, and DART rates. It also requests the contractor's NAICS code, who administers their safety program, and experience modification rates for the past three years. The federal contract opportunity is a fixed-price bid/build contract to renovate walls, floors, and ceilings across approximately 29,785 square feet of the spinal cord building. The scope includes renovating hallways, patient rooms, and staff areas but excludes telecom rooms and areas with ceramic tile or epoxy flooring. Contractors must provide all materials, tools, labor, PPE, and supervision to complete the project.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment H Floor Plan Spinal Cord - AREAS WITH WALLPAPER.pdf | ||
| Attachment F Site Plan - 546-23-115 - Renovate Spinal Cord.pdf | ||
| S02 ATTACHMENT D SPECIALIZED EXPERIENCE FROM.pdf | ||
| S02 ATTACHMENT B PRICE MATRIX.xlsx | XLSX spreadsheet | |
| S02 36C24823R0107 - Renovate Spinal Cord.pdf | ||
| S02 ATTACHMENT E PAST PERFORMANCE QUESTIONNAIRE.pdf | ||
| Attachment I OF EXISTING HANDRAILS INCLUDING WALL PROTECTION-FIBRE REINFORCED PLASTIC - FRP.pdf | ||
| Attachment A Wage Determination..txt | TXT text file | |
| Attachment G Floor Plan Spinal Cord - BATHROOMS EXCLUDED AREAS.pdf |
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Text version
EMR FORM FOR BIDDER/OFFEROR TO COMPLETE & SUBMIT WITH PROPOSAL
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 .