Solicitation Attachment E - EMR.docx
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- Solicitation number
- 36C24823R0040
About this file
This document contains an EMR form for bidders and offerors to complete and submit with proposals for federal contract opportunity 36C24823R0040. The form requests safety and health-related information from bidders, including OSHA 300 and 300a forms from the previous three years detailing man hours, cases involving days away from work or restricted activity, and DART rates. Bidders must provide their NAICS code, identify who administers their safety and health program, and disclose insurance EMR rates for the past three years, with any rate over 1.0 disqualifying the bidder. The opportunity is for the buildout of an emergency management site at Lakemont and refers to solicitation 36C24823R0040 and attachments A through H.
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Attachment E – EMR Form
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 |
| 2019 |
| 2020 |
| 2021 |
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 .