S02 Contractor EMR Certification Form.docx
DOCX document 17 KB Posted
- Attached to
- Z1DA--Provide Interior Cooling 539-21-202 Federal contract opportunity
- Solicitation number
- 36C25021B0006
About this file
This document contains a pre-award contractor evaluation form and details of a related federal contract opportunity for interior cooling services. The evaluation form requests safety and environmental records from interested contractors, including OSHA forms from the past three years, insurance experience modification rate, and NAICS code. The related opportunity is a 100% set-aside for small businesses with an SDVOSB preference. It is issued by the Department of Veterans Affairs for interior cooling services at the Cincinnati VAMC with a project magnitude between $500,000 and $1,000,000. The NAICS code is 238220 and the business size standard is $16.5 million. The solicitation number is 36C25021B0006 and offers are due on or around December 28, 2020. Interested contractors must register on relevant websites and provide the safety and environmental documents requested in the evaluation form to be eligible for award. The duration of any award shall not exceed 365 days.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Site Visit.pdf | ||
| 539-21-202 addendum 1 interior cooling.pdf | ||
| 36C25021B0006 0001.docx | DOCX document | |
| Wage Determination.pdf | ||
| S02 RFI Form.docx | DOCX document | |
| 539-21-202_CD_SPECS_2020.1112-revised.pdf | ||
| 539-21-202_Dwgs_CD_2020-1028.pdf | ||
| 36C25021B0006_2.docx | DOCX document |
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Project 539-21-202:
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 .