S02 - Wage Determination Jan 21 - 515-21-110.pdf

This document is a pre-award contractor experience modification rate form for solicitation number 36C25022B0016 to repair roads, sidewalks, and parking areas for the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10. The form requests contact information and safety data for the past three years including man hours, OSHA recordable incidents, days away from work rates, and serious violations. Attachments requested include 2020 OSHA forms and a letter from the bidder's insurance carrier with the current experience modification rate. The bidder must also provide their six-digit NAICS code and the name and title of the person who administers their safety and health program.