Orange County NC Website
Browse       Search
DocuSign Envelope ID:2C304718-BA25-4043-9BDC-F17B3EF664D8 <br /> YEAR CONTRACTOR INDUSTRY INDUSTRY FIELD AND CODE <br /> DART DART <br /> INCIDENT RATE INCIDENT RATE <br /> 2014 1.65 1 3.3 Roofing Contractors/23816 <br /> 2013 0,98 33 Roofing Contractors 123816 <br /> 2012 1.69 3.3 Roofing Contractors/23816 <br /> 2. Experience Modification are (EMR). Provide the bidder's rnost recent <br /> Experience Modification Rate (EMR) based on insurance claims history, The bidder <br /> mustprovitle the source qj'1he F—WR information anci contaef info •inalion of insurer-enlity <br /> proviefing the EjWR. <br /> YEAR CONTRACTOR INDUSTRY FIELD AND NAME AND CONTACT-- <br /> EVER CODE INFO FOR E <br /> INFORMATION <br /> Roofing Contractors NFP Corporate Services <br /> 711/2015 to <br /> 7/1/2016 1 U9 23816 Mitzi Hines <br /> 704,9719501 <br /> -----------------------------i- <br /> 3 Answer the following 0S14A Specific Questions: <br /> (a) Within tLe last 2 years., has the bidder received any citations classified by <br /> OS11 A as being(I) serious, (2) willful and"or(3)repeat violations where your <br /> company operates? <br /> Yes No <br /> If yes, attach a COPY of Cade SUCh citation and violotiom, <br /> (b) Has the bidder experienced any work-related fatalities within the last five <br /> years'? <br /> Yes No <br />