VA250-17-R-0136-032.pdf
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- Attached to
- VISN 10 JOB ORDER CONTRACT IDIQ Federal contract opportunity
- Solicitation number
- VA25017R0136
About this file
This document outlines requirements for a Veterans Integrated Service Network 10 indefinite delivery/indefinite quantity job order contract solicitation. The solicitation will result in the award of 10 firm fixed-price IDIQ contracts for general construction services under $500,000 to support 10 VA medical centers across five states. Services will include maintenance, alterations, repairs, and small construction projects. Responses are due in September 2017. Awards will be made to service-disabled veteran-owned small businesses based on technical capability, past performance, and price. Individual task orders will have values between $2,000 and $500,000, and maximum contract values are $5 million per base year and option year. The solicitation will be open only to SDVOSBs and have a 100% set-aside at the NAICS code 236220 for commercial and institutional building construction with a $36.5 million size standard.
VA250-17-R-0136 Attachment 5 - Contractor EMR Form.pdf
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Text version
ATTACHMENT 5
CONTRACTOR EXPERIENCE MODIFICATION RATE (EMR) FORM
Company Name: ________________________________________________________
Address: ______________________________________________________________
Telephone: ____________________________________________________________
Email: ________________________________________________________________
Contact: ______________________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2014 2015 2016 2017
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): ________________________________
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