S02 - Contractor Certification Regarding Safety and Environmental.docx

This document is a contractor certification form regarding safety and environmental compliance for solicitation number 36c25020b0029 for Z1DA--553-17-101 Anti Climb Fencing from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10. The form requires the contractor to disclose the number of serious, willful, or repeat OSHA violations in the last three years and provide an explanation for any violations, as four serious, one repeat, or one willful violation could result in a determination of non-responsibility. The contractor must also disclose its current insurance experience modification rate and provide a signed letter from its insurance carrier on letterhead supporting the provided rate. In addition, the contractor's authorized representative must sign and type their name and title on the form.