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DocuSign Envelope ID: B49FB256 -4ADF- 4759- AF63- 134AD44FC239 <br />YEAR <br />CONTRACTOR <br />DART <br />INCIDENT RATE <br />INDUSTRY <br />DART <br />INCIDENT RATE <br />INDUSTRY FIELD AND CODE <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 />YEAR <br />CONTRACTOR <br />EMR <br />INDUSTRY FIELD AND <br />CODE <br />NAME AND CONTACT <br />INFO FOR EMR <br />INFORMATION <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 <br />