Safety or Environmental Violations and EMR Information - 2 pages.pdf
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- Attached to
- J063 - Upgrade Fire Alarm System , VA Black Hills Health Care System - Fort Meade Campus
- Solicitation number
- 36C26326B0015
About this file
This document is a pre-award contractor safety and environmental record evaluation requirement and accompanying form for federal contract solicitations.
All bidders and offerors must submit certification of their safety and environmental records, confirming no more than three serious, one repeat, or one willful OSHA or EPA violation(s) within the past three years. Contractors unable to meet this threshold must provide detailed explanations and circumstantial information regarding violations. Additionally, all contractors must submit their current Experience Modification Rate (EMR) obtained from their insurance carrier on letterhead. If the EMR exceeds 1.0, contractors must provide a written explanation from the insurance carrier detailing reasons for the elevated rate and the anticipated date for reduction to 1.0 or below. Self-insured contractors or those in non-traditional insurance states (CA, DE, MI, NJ, ND, OH, PA, WA, WY, and PR) must obtain EMR ratings from the National Council on Compensation Insurance (NCCI) using form ERM-6 or from their state-run worker's compensation insurance rating bureau. If NCCI cannot issue an EMR due to lack of insurance history, contractors must submit letters from both their insurance carrier and NCCI confirming a Unity Rating of 1.0. The submitted information, combined with government system data from OSHA and EPA inspection databases, will determine initial contractor responsibility. This requirement applies to all subcontracting tiers, with prime contractors responsible for ensuring subcontractor responsibility.
The accompanying Pre-Award Contractor Safety and Environmental Record Evaluation Form requires contractors to provide company information, complete a four-year table documenting man-hours, OSHA 300 injury cases, DART rates, and serious/willful/repeat violations, submit copies of OSHA 300 and 300a forms, identify the NAICS code (238210 - Electrical Contractors and Other Wiring Installation Contractors), name the safety and health program administrator, and report the company's current EMR.
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FOR OFFICAL USE ONLY 1 of 2
Safety or Environmental Violations and Experience Modification Rating Information
1. All Bidders/Offerors shall submit information pertaining to their past Safety and Environmental record. The information must contain 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. If such certification cannot be made, a Bidder/Offeror shall explain why and submit as much information as possible regarding the circumstances of its past safety and environmental record, including the number of EPA violations and/or the number of serious, repeat, and/or willful OSHA violations, along with a detailed description of those violations.
2. All Bidders/Offerors shall submit information regarding their current Experience Modification Rate (EMR). This information shall be obtained from the Bidder’s/Offeror’s insurance carrier and be furnished on the insurance carrier’s letterhead. If a Bidder/Offeror’s EMR is above 1.0, Bidder/Offeror must submit a written explanation of the EMR from its insurance carrier furnished on the insurance carrier’s letterhead, describing the reasons for the elevated EMR and the anticipated date the EMR may be reduced to 1.0 or below.
3. 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 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 worker’s compensation insurance rating bureau.
4. If the NCCI cannot issue an EMR because the Bidder/Offeror lacks insurance history, Bidder/Offeror shall submit a letter indicating so from its insurance carrier furnished on the insurance carrier’s letterhead and include a letter from the NCCI indicating that is has assigned Bidder/Offeror a Unity Rating of 1.0.
5. 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 an initial Determination of Responsibility.
6. This requirement is applicable to all subcontracting tiers, and prospective prime contractors are responsible for determining the responsibility of their prospective subcontractors.
FOR OFFICAL USE ONLY 2 of 2
PRE-AWARD CONTRACTOR SAFETY AND ENVIRONMENTAL RECORD
EVALUATION FORM
Information provided below is current and applicable to Solicitation:
Company Name: ___________________________________________________________ Address:
Telephone: Fax:
Email:
Contact:
Utilizing the completed OSHA 300 Forms, please complete the table below:
Category 2022 2023 2024 2025 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.
Please attach copies of the following documents: OSHA 300 (Log of Work-Related Injuries and Illnesses) and 300a Forms (Summary of Work-Related Injuries and Illnesses).
These forms can be accessed through the OSHA publications search page: http://www.osha.gov/pls/publications/publication.html.
1. Provide six-digit North American Industrial Classification System (NAICS) Code for this acquisition: 238210 - Electrical Contractors and Other Wiring Installation Contractors
2. Who administers your company’s Safety and Health Program?
3. Company’s Insurance Experience Modification Rate (EMR):
http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .