S02 EMR Sheet 2025.pdf
PDF 138 KB Posted
- Attached to
- Z1DA--36C26125R0024 | 36C261-25-AP-0208 | VASNHS Concrete Pad, Fisher House Storage, Bldg. 8 | PM | 593
- Solicitation number
- 36C26125R0024
About this file
This is a Safety & Environmental Record and Experience Modification Rate (EMR) certification form required under VHA Directive 7715 for contractor qualification. The form requires contractors to document their OSHA and EPA violations from 2022-2025, as well as their current EMR rate.
To be eligible for consideration and award, contractors must meet two key requirements: 1) Have no more than three serious violations, or one repeat violation, or one willful OSHA/EPA violation in the past 3 years, and 2) Maintain an EMR of 1.0 or less. Contractors must provide a self-certification on company letterhead regarding their safety/environmental record and submit their current EMR information on their insurance carrier's letterhead. If a contractor's EMR exceeds 1.0, they must provide a written explanation from their insurance carrier describing the reasons and anticipated date for reduction below 1.0.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26125R0024 0003.docx | DOCX document | |
| S04 Site Walk Sign In Sheet Concrete 20250211.pdf | ||
| 36C26125R0024 0002.docx | DOCX document | |
| 36C26125R0024 0001.docx | DOCX document | |
| S02 WD NV20250038 rev 20250124.pdf | ||
| S02 Specs Complete 20241206 Fisher House Storage Concrete.pdf | ||
| S02 Drawings FH Storage Pad 27Sep.pdf | ||
| S02 Price Breakdown by Division sheet 36C26125R0024 Concrete.pdf | ||
| S02 VASNHS Site Map.pdf | ||
| 36C26125R0024.docx | DOCX document | |
| S02 RFI Form 36C26125R0024 Concrete.pdf |
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Text version
PER VHA DIRECTIVE 7715 (06 April 2017) - SAFETY &
ENVIRONMENTAL RECORD AND EXPERIENCE MODIFICATION
RATE (EMR):
Contractor Certification Regarding Project:
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) in 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 offer.
1. SAFETY & ENVIRONMENTAL RECORD: A self-certification on company letterhead that the contractor has no more than three (3) serious, or one (1) repeat or one (1) willful OSHA or any EPA violation(s) in the past three years.
2. EMR: All Offerors shall submit information regarding their current EMR. This information shall be obtained from the Offerors’s insurance carrier and be furnished on the insurance carrier’s letterhead. If an Offeror’s EMR is above 1.0, Offeror shall submit a written explanation of the EMR from its insurance carrier furnished on the insurance carrier’s letterhead, describing the reasons for the EMR, and the anticipated date the EMR may be reduced to 1.0 or below.
2022 2023 2024 2025 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.)
Number of violations from EPA within the last 3 years. Please attach explanation for any violations.
Company’s Current Insurance Experience Modification Rate (EMR) =
(Note: Contractor must support the EMR with a signed letter from Insurance Carrier on their letterhead.)
Signature:
Print Name:
PER VHA DIRECTIVE 7715 (06 April 2017) - SAFETY & ENVIRONMENTAL RECORD AND EXPERIENCE MODIFICATION RATE (EMR):
File details come from the government source that posted it. Updated .