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DocuSign Envelope ID:4E43C797-33A3-4C29-9D23-96EA82AC437C <br /> YEAR CONTRACTOR INDUSTRY INDUSTRY FIELD AND CODE <br /> DART .DART <br /> INCIDENT RA'Z'E INCIDENT RATE <br /> 2-C) I <br /> 2, Experience Modification Rate(EMR). Provide tale bidder's most recent <br /> Experience Modification Rate(EMR)based on insurance claims history. The bidder <br /> must provide the source cif the EIIIR irtfornuriiou and contact iufru-mation ofinsru'er entity <br /> Providing the Eilk Z, <br /> YEAR CONTRAC'T'OR INDUSTRY FIELD AND NAME AND CONTACT <br /> EMR CODE INFO FOR EMR <br /> INFORMATION <br /> 511 l`°t -- 5(f'"A Donn Gns, <br /> M � � �r y6_4�104 <br /> 3, Answer the following OSHA Specific Questions: <br /> (a) Within the lest 2 years,has the bidder received any citations classified by <br /> OSHA as being(1)Safious,(2) willful and/or(3)roheat 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 <br />