S02 - Attachment - EMR Sheet.docx
DOCX document 17 KB Posted
- Solicitation number
- 36C26126R0050
About this file
This is a contractor certification attachment document establishing Safety and Environmental Record and Experience Modification Rate (EMR) eligibility requirements for the Building 12 Pump Power Relocation project at VA Sierra Nevada Health Care System in Reno, Nevada (Solicitation Number 36C26126R0050). Per VHA Directive 7715, contractors must demonstrate compliance with specific safety and environmental standards to be considered for award.
To qualify, contractors must certify they have no more than three serious violations, one repeat violation, or one willful OSHA or EPA violation within the past three years, and must maintain an Experience Modification Rate (EMR) of 1.0 or below. Offerors are required to submit: (1) a self-certification on company letterhead confirming their compliance with the violation thresholds, and (2) current EMR documentation obtained from their insurance carrier on the carrier's letterhead. If an offeror's EMR exceeds 1.0, the insurance carrier must provide a written explanation describing the reasons for the elevated rate and the anticipated timeline for reduction to 1.0 or below. The document includes a table requiring contractors to report the number of OSHA violations (serious, willful, or repeat), EPA violations, and current EMR for the years 2022 through 2025, with required attachments explaining any violations. All submissions must be signed and include the contractor's printed name.
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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.
| 2022 |
| 2023 |
| 2024 |
| 2025 |
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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