7-Exhibit G.pdf
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- Solicitation number
- RFP-JC-3837
- Issued by
- Riverside County, California
About this file
This document is Exhibit G, a Cal/OSHA Compliance History form for a contractor, specifically for the Eastern Municipal Water District (EMWD). The form requires a contractor to disclose their safety compliance history by answering two critical questions: whether they have been cited by Cal/OSHA or any regulatory agency for safety or environmental violations in the past seven years, and whether they have experienced a serious incident or fatality on a job site within the past ten years.
The form is designed for risk management purposes, with sections for the contractor to provide details about any violations or incidents, and space for EMWD's Purchasing and Risk Management departments to review and approve the submission. If the contractor answers "Yes" to either question about safety violations or serious incidents, they are required to provide specific information about the incident(s) and actions taken to prevent future occurrences. The document includes fields for the contractor's name, contact information, standard industry code, contractor's license number, and requires a signature from the contractor's representative.
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Text version
EXHIBIT G
CONTRACTOR’S CAL/OSHA COMPLIANCE HISTORY
Date:
Contractor’s Standard Industry Code:
Contractor’s Name:
California State Contractor’s License #:
Address:
Contact Person:
Phone No:
Please answer the following questions:
1. Has the contractor been cited by Cal/OSHA or any regulatory agency for a violation related to safety or environmental issues within the past seven (7) years?
No Yes
2. Within the past ten (10) years has the contractor had a serious incident or fatality on a job site?
No Yes
* If yes to # 1 or #2, please provide information specific to the incident(s) and action(s) taken to ensure that there is not a repeat violation, or incident(s) (attach additional sheets if needed)
Contractor’s Representative signature: Date:
FOR EMWD USE ONLY: Purchasing to forward to Risk Management for review
Date:
(Risk Management)
Approved: No Yes
Reviewed by (Risk Management)
(signature required)
File details come from the government source that posted it. Updated .