S02 Contractor Certification RE Safety and EMR.docx
DOCX document 15 KB Posted
- Solicitation number
- 36C26124R0059
About this file
This document is a Contractor Certification Regarding Safety and Environmental Record and Experience Modification Rate (EMR) for a federal contract opportunity.
The key requirements are that the contractor must have no more than three serious, one repeat, or one willful OSHA or EPA violations within the past three years, and an EMR of 1.0 or less. Offerors must submit a self-certification with the specified violation details and their current EMR, which must be supported by a signed letter from their insurance carrier.
The related federal contract opportunity is for construction services for Project No. 570-22-219, Consolidate Sterile Supply Rooms, with a solicitation number of 36C26124R0059. The RFP is due on July 19, 2024 at 12:00 PM Pacific and proposals should be sent to kayla.haruguchi@va.gov. The contracting agency is the Department of Veterans Affairs, Veterans Health Administration, Veterans Integrated Service Network 21.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26124R0059 0002.docx | DOCX document | |
| 36C26124R0059 0001.docx | DOCX document | |
| 852.219-75 - VA Notice of Limitations on Subcontracting--Certificate of Compliance for SErvices and Construction - JAN 2023 Deviation.docx | DOCX document | |
| S02 - RFI Form - 36C26124R0059.docx | DOCX document | |
| 570-22-219 Construction Specifications.pdf | ||
| 570-22-219 Construction Drawings -.pdf | ||
| S02 Price Breakdown.xlsx | XLSX spreadsheet | |
| 36C26124R0059.docx | DOCX document |
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Text version
CONTRACTOR CERTIFICATION REGARDING SAFETY AND ENVIRONMENTAL
Contractor Certification Regarding Project: 36C26124R0059 – Consolidate Sterile Supply Rooms, Project # 570-22-219 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) within 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 bid/proposal:
SAFETY & ENVIRONMENTAL RECORD: A self-certification on company letterhead that the Offeror has no more than three (3) serious, or one (1) repeat or one (1) willful OSHA or any EPA violation(s) within the past three years. Include the following table and signature block.
| 2021 |
| 2022 |
| 2023 |
| 2024 |
Number of serious, willful, or repeat violations from OSHA within the last 3 years.
Number of serious, willful, or repeat violations from EPA within the last 3 years
Signature: ______________________________________________ Typed Name: ______________________________________________________ Title: ______________________________________________________
EMR: All Offerors shall submit information regarding their current EMR. This information shall be obtained from the Offeror’s insurance carrier and be furnished on the insurance carrier’s letterhead.
Contractor’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 .