S02 - Attachment - EMR Sheet.docx
DOCX document 16 KB Posted
- Solicitation number
- 36C26125R0057
About this file
This document is an Attachment - EMR (Experience Modification Rate) Sheet for a VA utility services contract, outlining specific safety and environmental compliance requirements for potential contractors. The sheet mandates that contractors must have no more than three serious, or one repeat, or one willful OSHA or EPA violations in the past three years, and maintain an Experience Modification Rate (EMR) of 1.0 or less. Contractors are required to submit a self-certification on company letterhead detailing their safety record and provide documentation from their insurance carrier verifying their current EMR. If a contractor's EMR exceeds 1.0, they must submit a written explanation from their insurance carrier describing the reasons for the higher rate and a projected timeline for reducing it to 1.0 or below. The document is associated with Solicitation Number 36C26125R0057 for providing utility services at the VA Sierra Nevada Health Care System Ioannis A. Lougaris Medical Center.
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Text version
PER VHA DIRECTIVE 7715 (06 April 2017) - SAFETY & ENVIRONMENTAL RECORD AND EXPERIENCE MODIFICATION RATE (EMR):
Contractor Certification Regarding Project:
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 Offerors shall submit the following information pertaining to their past Safety & Environmental Record and EMR with their offer.
1. SAFETY & ENVIRONMENTAL RECORD: A self-certification on company letterhead that the contractor 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.
2. EMR: All Offerors shall submit information regarding their current EMR. This information shall be obtained from the Offerors’s insurance carrier and be furnished on the insurance carrier’s letterhead. If an Offeror’s EMR is above 1.0, Offeror shall submit a written explanation of the EMR from its insurance carrier furnished on the insurance carrier’s letterhead, describing the reasons for the EMR, and the anticipated date the EMR may be reduced to 1.0 or below.
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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.)
Number of violations from EPA within the last 3 years. Please attach explanation for any violations.
Company’s Current Insurance Experience Modification Rate (EMR) = (Note: Contractor must support the EMR with a signed letter from Insurance Carrier on their letterhead.)
Signature:
Print Name:
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