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DocuSign Envelope ID: 313DA256 -1 EDE- 4396- A716- 4C53B809027E <br />YEAR CONTRACTOR INDUSTRY <br />DART DART <br />INCIDENT RATE INCIDENT RATE <br />2016 <br />0.00 <br />1.6 <br />2015 <br />0.00 <br />1.8 <br />2014 <br />0.00 <br />1.9 <br />INDUSTRY FIELD AND CODE <br />Construction of Buildings <br />NAICS Code 236 <br />oRto <br />i <br />NAICS Code 236 <br />2. ExI2 erience Modification RaIeEM[R, . 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 />YEAR CONTRACTOR INDUSTRY FIELD AND <br />EMR CODE <br />2016/2017 1.22 Nonresidential Building <br />Construction <br />NAICS Code 2362 <br />3. Answer the following OSHA Specific Questions: <br />NAME AND CONTACT <br />INFO FOR EMR <br />INFORMATION <br />James Kirkpatrick <br />SIA Group <br />910 -478 -3313 <br />910 -455 -7576 <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 X <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 X <br />