PSM_-_Contractor_Annual_Audit_Form.pdf

PDF 143 KB Posted

Attached to
Congestion Relief Alternative for SR99 State and local contract opportunity
Solicitation number
2026-RFP-009
Issued by
Polk County, California

About this file

This is a Contractor Annual Audit Form from the City of Lakeland, Risk Management and Purchasing department designed to assess contractor performance and compliance. The form is structured to document audit results and comments across multiple audit items, with a primary focus on EMR (Experience Modification Rate) evaluation. The document serves as a standardized tool for conducting annual audits of contractors engaged with the City of Lakeland, requiring completion with contractor name, date, project identification, and location information. While the specific audit criteria are not fully detailed in the provided excerpt, the form establishes a systematic approach to reviewing contractor qualifications and regulatory compliance on an annual basis.

The audit form does not address pricing terms, set-asides, incumbent contractor status, or funding requirements, as it functions as an administrative compliance and performance review document rather than a procurement solicitation or contract award instrument. The form's primary utility is to maintain records of contractor audits for risk management purposes and to ensure that contractors maintain appropriate insurance and safety standards throughout their engagement with the City. This tool is essential for the City's vendor management process and supports ongoing contractor oversight and accountability.

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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 .