Agenda 02-03-2026; 8-h - Approval of Prequalification Assessment Tool for the Crisis Diversion Facility

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Gilbane Building Company 13 Prequalification Form for First-Tier Subcontractors under CM at Risk Orange County Crisis Diversion Facility 2.8. Convicted of Conflicts of Interest/Bribery/Bid-Rigging Has your present company, its officers,owners, or agents ever been convicted of charges relating to conflicts of interest, bribery, or bid rigging? =Yes =No If yes, state the project name(s),year(s), and reason why: (Prequalification Ratings Matrix: If yes,give 0 points. If no,give 3 points.) 2.9.113arred From Public Work in NC Has your present company, its officers,owners, or agents ever been barred from bidding public work in North Carolina? =Yes =No If yes, state the project name(s),year(s), and reason why: (Prequalification Ratings Matrix: If yes,give 0 points. If no,give 3 points.) 2.10a Safety- EMR Rating List your company's Experience Modification Rate (EMR)for the past three years. Present Rate: Previous Rate: Year Before Rate: If EMR is greater than 1.00 for any given year attach OSHA 300 Log and 300A Summaries for previous 5 years. Attached? =Yes =No (Prequalification Ratings Matrix: Submission of Safety Records is a REQUIREMENT for prequalification submission. If EMR is 1.0 or less give 2 points. If no,give 0 points.) If these rates reflect corporate performances over a number of locations, please explain,to the extent possible,the performance experience of the location serving this project: 2.10b Safety-OSHA citations Has your company been issued any OSHA citations/penalties, NC Department of Labor citations/penalties or had any jobsite fatalities in the past 3 years? =Yes =No If yes, please provide specific explanation: (Prequalification Ratings Matrix: If yes without sufficient explanation,give 0 points. If no or sufficient explanation provided,give 3 points. Page 9 112