S02 Contractor EMR Certification Form.docx
DOCX document 17 KB Posted
- Attached to
- Z1DA--Improve Exhaust System 539-18-101 Federal contract opportunity
- Solicitation number
- 36C25020B0068
About this file
This document contains a pre-award contractor evaluation form and details of a related federal contract opportunity. The evaluation form requests safety and environmental record information from contractors, including OSHA forms, violation details, and insurance experience modification rates. The related federal contract opportunity is a solicitation from the Department of Veterans Affairs to improve an exhaust system at the Cincinnati VAMC. It is a 100% set-aside for small businesses with a preference for service-disabled veteran-owned small businesses. Offerors must be registered and verified in relevant databases, and able to provide safety and environmental violations and experience modification rates. The project magnitude is between $500,000 and $1,000,000, and the NAICS code is 238220. The duration is 180 days from notice to proceed, and bonds will be required.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25020B0068 0003.docx | DOCX document | |
| 539-18-101 ADDENDUM 3 WRITE UP.pdf | ||
| 539-18-101 Addendum 3 Dwgs.pdf | ||
| Corbin Russwin Locksets Sole Source Justification Redacted.pdf | ||
| S04 Site Visit Sign in Sheet.pdf | ||
| 01 00 00 ADDENDUM 2.pdf | ||
| Revise Bid Schedule Statement of Bid Items.docx | DOCX document | |
| Addendum 2 Drawings Revisions are clouded.pdf | ||
| 36C25020B0068 0002.docx | DOCX document | |
| Location of temporary door storage.pdf | ||
| Addendum 2 Specifictions Revisons write up.pdf | ||
| 36C25020B0068 0001.docx | DOCX document | |
| 36C25020B0068.docx | DOCX document | |
| 539-18-101 CD Bid Specifications (8-21-2020).pdf | ||
| Wage Determination OH20200082.pdf | ||
| S02 RFI Form.docx | DOCX document | |
| 539-18-101 CD Bid Drawings (8-21-2020).pdf |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Project 539-18-101:
Company Name: Address: Telephone: Fax: Email: Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2016 |
| 2017 |
| 2018 |
| 2019 |
Number of man hours (jobsite and office).
Number of cases involving days away from work, restricted activity, or both (Column H and I of OSHA 300).
Days away, restricted, or transferred rate (# of days away, restricted, or transferred cases x 200,000/# of man hours) (DART Rate).
Number of serious, willful, or repeat violations from OSHA within the last 3 years. Please attach explanation for any violations.
Please attach copies of the following documents: OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page: http://www.osha.gov/pls/publications/publication.html.
2. Provide six-digit North American Industrial Classification System (NAICS) Code for this acquisition: 238220
3. Who administers your company’s Safety and Health Program?
4. Company’s Insurance Experience Modification Rate (EMR):
File details come from the government source that posted it. Updated .