S02_ EMR.pdf
PDF 77 KB Posted
- Attached to
- Z2JZ--FY24: NRM (PROJ: 516-23-604) Install Temp Shoring in Crawl Space at Building 1 (Specialized Contract)
- Solicitation number
- 36C24824Q0071
About this file
This document contains a pre-award contractor evaluation form and details for a federal contract opportunity to install temporary shoring in a crawl space at a Department of Veterans Affairs building. The evaluation form requests the contractor's OSHA 300 forms from 2019 to 2021 detailing man hours, cases involving days away from work or restricted activity, and days away/restricted/transferred rate. It also asks for the contractor's six-digit NAICS code, safety program administrator, and experience modification rates for the past three years. The related federal contract opportunity is solicitation number 36C24824Q0071 to install temporary shoring at a crawl space at Building 1 for the Veterans Health Administration Veterans Integrated Service Network 8. Submissions are due as detailed in the solicitation. The pre-award evaluation focuses on safety qualifications relevant to the temporary shoring installation work required by the opportunity.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| RFI QA Temporary Shoring Crawl Space BPVAMC-516-23-604-RFI 12072023.xlsx | XLSX spreadsheet | |
| 36C24824Q0071 0005_1.docx | DOCX document | |
| Temp Shoring Site Visit Sign in Sheet.pdf | ||
| 36C24824Q0071 0004_1.docx | DOCX document | |
| RFI QA Temporary Shoring Crawl Space BPVAMC-516-23-604-RFI 11302023.xlsx | XLSX spreadsheet | |
| 36C24824Q0071 0003.docx | DOCX document | |
| RFI QA Temporary Shoring Crawl Space BPVAMC-516-23-604-RFI.xlsx | XLSX spreadsheet | |
| 516-23-604 2023 11 09 Site Walk Sign In.pdf | ||
| 36C24824Q0071 0002_1.docx | DOCX document | |
| 07_Specifications_516-23-604_Specialized-Services _Rev1.pdf | ||
| 36C24824Q0071 0001_1.docx | DOCX document | |
| S02_Portion of JS Held Report.pdf | ||
| S02_SCA WD 2015-4571.txt | TXT text file | |
| 36C24824Q0071_1.docx | DOCX document | |
| S02_Specifications_516-23-604_Specialized-Services.pdf | ||
| 36C24824Q0071.pdf | ||
| S02_SOW_Specialize_Service_Rev1_Final_w-Appendices 05_516-23-604_2023.pdf | ||
| S02_Past Performance Questionnaire.docx | DOCX document | |
| List of Attachments.pdf |
Show all 19
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
EMR FORM FOR BIDDER/OFFEROR TO COMPLETE & SUBMIT WITH PROPOSAL
Pre-Award Contractor Evaluation Form Company Name:
Address: _____________________________________________________
Telephone: ______________________ Fax: ________________________
Email: _______________________________________________________
Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2019 2020 2021 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. (Four serious, one repeat, or one willful disqualifies the contractor.)
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 your six-digit North American Industrial Classification System (NAICS) Code for this acquisition: __________________________________
3. Who administers your company’s Safety and Health Program?
4. Company’s Insurance Experience Modification Rate (EMR) for the past 3 years (an EMR of greater than 1.0 disqualifies the contractor): _____________
File details come from the government source that posted it. Updated .