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DocuSign Envelope ID:4E43C797-33A3-4C29-9D23-96EA82AC437C <br /> Couti-actot•'s Safety ReCOM Info>i cation <br /> The Contractor's safety record shall be reviewed and evaluated in addition to other duality and <br /> performance criteria as hart of bid evaluation process. Failure to provide the.requested <br /> information and doCL111lerrtation May result in rejection of your bid as non-responsive. <br /> Accordingly,all bidders must submit the following infornation regarding their safety record. <br /> The following definitions shall apply to this section: <br /> "DART incident rate"--Acronym for"Days Away,Restrictions and Transfers".The <br /> DART incident rate may be used to show the relative level of injuries and illnesses within <br /> a firm compared to the industry.It is based only on those injuries and illnesses severe <br /> enough to warrant"Days Away,Restrictions attd Transfers'', The DART incident rate is <br /> calculated using OSHA's Fotm 300 and the following formula; <br /> ((plumber of entries in column H (days away from work)+column 1{job transfer or <br /> restriction)x 200,000)/(Number of hours worked by all employees)=DART hrcident <br /> rate. <br /> "EMR"--Acronym for"Experience Modification Rate,"is an indicator of a contractor's <br /> past safety performance,widely used by the insurance industry as an equitable meads of <br /> detormining premiums for workers'compensation insurance. The rating system considers <br /> the average workers'compensation losses fora given firm's type of work and amount of <br /> payroll and predicts the dollar amount of expected losses to be paid by that employer in a <br /> designated rating period,usually three years.The rating is based on comparison of firms <br /> doing similar types of work,and the employer is rated against the average expected <br /> performance in each work classification. Losses incurred by the employer for the rating <br /> Period are then compared to the expected losses to develop an experience rating-. <br /> "OSHA"—Acronym for the Federal Oecirpational Health and Safety Administration. <br /> The term"OSHA"as used in this Policy also rcPors to any state or local agency having <br /> jurisdictional authorization to enforce worker safety requirements and assess fines or <br /> warnings for violation of worker safety standards. <br /> I, OSHA DART Incident Rate. Provide the bidder's DART Incident Rate <br /> calculated from OSHA's Form 300 for the last three years and the other required <br /> information shown in the example table below. The bid ler nurst attach all m1p1wrthig <br /> documentation aril calculations inchiding cert{Jied OSHlf forms, <br /> I <br />