S02-ATTACHMENT - Contractor Certification Regarding Safety and Environmental.docx
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- Attached to
- Z1DA--Exterior Painting - BLDGs 208, 5, 7, and BLDG 1 Connection | 36C26123R0044 | 662-23-2-6451-0007
- Solicitation number
- 36C26123R0044
About this file
This solicitation requests proposals for exterior painting services at multiple buildings at the San Francisco VA Medical Center. Offerors must provide all labor, materials, transportation, overhead and profit to paint the exteriors of buildings 208, 7, 5, and connect building 1. The requirement is set aside for verified service-disabled veteran-owned small businesses. Proposals are due by June 16, 2023 at 2:00pm Pacific Time. The government intends to award a firm-fixed price contract without discussions and based on price alone. The period of performance is 120 days from notice to proceed. Offerors must certify no more than three serious or one repeat/willful OSHA or EPA violations in the past three years and an experience modification rate of 1.0 or less.
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ATTACHMENT B – 36C26123R0044
CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL
Contractor Certification Regarding Project: 662-23-123 Titled, Exterior Painting - Bldgs. 208, 5, 7, and Connection to Bldg. 1 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) in the past 3 years and have an EMR of equal to or less than 1.0.
All Bidders 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 bidder has no more than three (3) serious, or one (1) repeat or one (1) willful OSHA or any EPA violation(s) in the past three years. Include the following table and signature block.
| 2019 |
| 2020 |
| 2021 |
Number of serious, willful, or repeat violations from OSHA within the last 3 years.
Number of EPA violations within the last 3 years
Signature: ______________________________________________ Typed Name: ______________________________________________________ Title: ______________________________________________________
EMR: All bidders shall submit information regarding their current EMR. This information shall be obtained from the bidder’s insurance carrier and be furnished on the insurance carrier’s letterhead.
Company’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 .