Attachment 4 - Contractor Certification Regarding EMR.docx
DOCX document 13 KB Posted
- Solicitation number
- 12905B20R0013
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| Attachment 5 - ARS 371.pdf | ||
| Attachment 2 - SOW Replace Roof - Logan UT 3-27-20.pdf | ||
| Attachment 8 - Past Performance Capability Information.docx | DOCX document | |
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| Attachment 7 - RFI FORM.DOCX | DOCX document | |
| 12905B20R0013.pdf |
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Text version
Contractor Certification Regarding Project: Replace Roof on Main Building, Logan, UT.
| 2016 |
| 2017 |
| 2018 |
| 2019 |
Number of serious, willful, or repeat violations from OSHA within the last 4 years. Please attach explanation for any violations. (Four serious, one repeat, or one willful violation could result in being determined non-responsible.)
Company’s Current Insurance Experience Modification Rate (EMR) = _____________ (Note: Contractor must support the EMR with a signed letter from Insurance Carrier on their letterhead.)
Signature: ______________________________________________
Typed Name: ______________________________________________________
Title: ______________________________________________________
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