S02 - Attachment - EMR Sheet.docx
DOCX document 17 KB Posted
- Solicitation number
- 36C26126R0050
About this file
This is a Safety and Environmental Record and Experience Modification Rate (EMR) Certification attachment for solicitation 36C26126R0050, a Department of Veterans Affairs project to relocate and add additional power legs to water pumps in Building 12 at the VA Sierra Nevada Health Care System in Reno, Nevada. Per VHA Directive 7715, contractors must meet specific safety and environmental compliance thresholds to be eligible for award: no more than three serious violations, one repeat violation, or one willful violation from OSHA or EPA within the past three years, and an Experience Modification Rate (EMR) of 1.0 or below.
All offerors are required to submit two certifications with their proposals. First, contractors must provide a self-certification on company letterhead confirming their OSHA and EPA violation history for the preceding three years. Second, offerors must submit their current EMR obtained from their insurance carrier on the carrier's letterhead; if the EMR exceeds 1.0, the contractor must provide a written explanation from the insurance carrier detailing reasons for the higher rate and the anticipated timeline for reduction to 1.0 or below. The attachment includes a data entry template requiring contractors to document the number of serious, willful, or repeat OSHA violations, EPA violations, and current EMR with supporting insurance documentation and contractor signature.
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| 36C26126R0050_1.docx | DOCX document | |
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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:
File details come from the government source that posted it. Updated .