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DocuSign Envelope ID:29F350EB-C553-4EEB-BD97-898B3775EE03 <br /> 2or� d ,1 &AIM 6,t4rw4ri <br /> �l� l�j Cztiter���ui G�tcY�Sz <br /> 2. Experience Modification Rate EMR . Provide the bidder's most recent <br /> Experience Modification Rate(EMR)based on insurance claims history. The bidder <br /> must provide the source of the EMR information and contact information of insurer entity <br /> providing the EMR- <br /> 3. Answer the following OSHA Specific Questions: <br /> (a) Within the last 2 years,has the bidder received any citations classified by <br /> OSHA as being(1) serious, (2)willful and/or(3)repeat violations where your <br /> company operates? <br /> Yes No <br /> If yes,attach a copy of each such citation and violation. <br /> (b) Has the bidder experienced any work-related fatalities within the last five <br /> years? <br /> Yes No t/ <br />