PSM_-_Contractor_Annual_Audit_Form.pdf

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Attached to
2026 Traffic Signal Cabinet & Controller Upgrades – Final Design
Solicitation number
2025-RFP-077
Issued by
Polk County, Illinois

About this file

This is a Contractor Annual Audit Form used by the City of Lakeland's Risk Management and Purchasing division for the Annual Fireworks Display Services contract. The form serves as a safety and compliance evaluation tool for contractors performing fireworks display services scheduled for December 4, 2025, during the Christmas Parade and July 3, 2026, during the Red, White & Kaboom event at Lake Mirror facility. The RFP #2025-RFP-077 was released on October 9, 2025, with questions due by October 21, 2025, and proposals due by October 30, 2025, at 2:00 pm. The contract includes potential renewal options for three consecutive years upon mutual consent. The audit form functions as a mandatory evaluation mechanism requiring contractors to demonstrate robust safety practices, protocols, and compliance documentation throughout the contract period.

The total budget allocation is $24,000, with $9,000 designated for the Christmas Parade fireworks display and $15,000 for the Red, White & Kaboom event. Contractors must provide comprehensive insurance coverage including commercial general liability, business automobile liability, workers' compensation, and excess liability, with insurance representing 35 percent of the evaluation criteria. Additional evaluation criteria include outline of show (35%) and references from the past five years (30%). Contractors are required to submit human trafficking affidavits, drug-free workplace certifications, and comply with local vendor preference policies. The audit form specifically addresses Employer's Mutual Rating (EMR) and other safety metrics, demonstrating the City's emphasis on workplace safety evaluation and compliance documentation as essential components of contractor qualification and ongoing contract performance.

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Text version

City of Lakeland, Risk Management and Purchasing

PSM- Contractor Annual Audit Form

Contractor: _____________________________________ Date: _______________

Project: _______________________________________________________________

Location: ______________________________________________________________

Audit Item Audit Result Comments

EMR (<1.0)

Drug and Alcohol Policy Written Safety Plan Safety Compliance Program

Safety Records Employee Training Records

Acceptable Safety Performance Onsite

Contractor, ___________________________________, ☐ is ☐ is not approved for continued inclusion on the PSM-Approved Contractors List.

Audit performed by: ______________________, Title: __________________________

Auditors signature: ______________________________________ Date: ___________

File details come from the government source that posted it. Updated .