8-RFP3871 - Exhibit G.pdf
PDF 170 KB Posted
- Attached to
- SCADA Graphics Standardization
- Solicitation number
- RFP-JC-3871
- Issued by
- Riverside County, California
About this file
This document is Exhibit G, a Cal/OSHA Compliance History form for a contractor, issued by Eastern Municipal Water District (EMWD). The form requires contractors to disclose their safety and environmental 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 in the past ten years.
The form is designed for risk management purposes, with a section for the contractor to provide detailed information about any violations or incidents, and space for EMWD's Purchasing and Risk Management departments to review and approve the submission. Contractors must provide their company details, including name, address, standard industry code, and contractor's license number, and the form requires a signature from the contractor's representative certifying the accuracy of the information provided.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .