S02 SAFETY AND ENVIRONMENTAL RECORD.pdf
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- Solicitation number
- 36C24226B0045
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This is a Safety and Environmental Record requirement document for federal contract bidding and award determination.
All bidders and offerors must submit certification of their safety and environmental compliance history, demonstrating no more than three serious violations, one repeat violation, or one willful violation from OSHA or EPA within the past three years. Bidders must also provide their current Experience Modification Rate (EMR) equal to or less than 1.0, obtained from their insurance carrier on letterhead. Self-insured contractors or those unable to provide EMR on insurance letterhead must obtain ratings from the National Council on Compensation Insurance, Inc. (NCCI) using form ERM-6, or from their state-run workers' compensation insurance rating bureau if located in CA, DE, MI, NJ, ND, OH, PA, WA, WY, or PR. The Government will conduct a Determination of Responsibility for the apparent awardee prior to award, utilizing the submitted information along with data from OSHA and EPA online inspection history databases. Failure to affirm compliance with these guidelines or submit required documentation results in a determination of Non-Responsibility and ineligibility for award. This requirement applies to all subcontracting tiers, with prime contractors responsible for verifying subcontractor responsibility. A certification form must be completed and signed by an authorized company representative, including printed name, title, signature, date, and company name and address.
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SAFETY AND ENVIRONMENTAL RECORD
All Bidders/Offerors shall submit the following information pertaining to their past Safety and Environmental record. The information shall contain, at a minimum, a certification that the bidder/offeror 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. All
Bidders/Offerors shall submit information regarding their current Experience Modification Rate (EMR) equal to or less than 1.0. This information shall be obtained from the bidder’s/offeror’s insurance company and be furnished on the insurance carrier’s letterhead. Self-insured contractors or other contractors that cannot provide their EMR rating on insurance letterhead must obtain a rating from the National Council on Compensation
Insurance, Inc. (NCCI) by completing/submitting form ERM-6 and providing the rating on letterhead from
NCCI. Note: Self-insured contractors or other contractors that cannot provide an EMR rating on insurance letterhead from the states or territories of CA, DE, MI, NJ, ND, OH, PA, WA, WY, and PR shall obtain their
EMR rating from their state-run workers’ compensation insurance rating bureau. A Determination of
Responsibility will be accomplished for the apparent awardee prior to processing the award. The above information, along with other information obtained from Government systems, such as the OSHA and EPA online inspection history databases, will be used to make the Determination of Responsibility. Failure to affirm being within the guidelines above or submit this information will result in a determination of “Non-
Responsibility” for the bidder/offeror. NOTE: Any information received by the Government that would cause a negative Determination of Responsibility will make the bidder/offeror ineligible for award. This requirement is applicable to all subcontracting tiers, and prospective prime contractors are responsible for determining the responsibility of their prospective subcontractors.
Certification:
I hereby certify that if awarded the contract, COMPANY NAME will comply with the limitations on subcontracting specified in this clause and in the resultant contract. I further certify that I am authorized to execute this certification on behalf of COMPANY NAME.
Printed Name of Signee: _______________________________________
Printed Title of Signee: ________________________________________
Signature: ___________________________________________________
Date: _______________________________________________________
Company Name and Address: ____________________________________
File details come from the government source that posted it. Updated .