S02_RFQ_Attachment_EMR.pdf
PDF 99 KB Posted
- Attached to
- 36C24822Q1498 PN 516-336 CWBYVAMC, Demolition of CITC and Site Restoration, CW Bill Young VAMC, Bay Pines FL
- Solicitation number
- 36C24822Q1498
About this file
This combined synopsis/solicitation requests quotations for demolition services at the C.W. Bill Young VA Medical Center in Bay Pines, Florida. Interested vendors must provide pricing to demolish the Cancer Infusion Treatment Center building and provide ongoing site security and safety. Quotes are due by August 31, 2022. The procurement is set aside for Service-Disabled Veteran Owned Small Businesses and has a North American Industry Classification System code of 238910 for site preparation contractors with a small business size standard of $16.5 million. The Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8 is the contracting agency. The solicitation incorporates provisions and clauses from Federal Acquisition Circular 2022-06 effective May 26, 2022.
View the file
Other files
Show all 18
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 2018 2019 2020
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 .