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

PSM - Contractor Annual Audit Form Summary

This document is a Contractor Annual Audit Form created by the City of Lakeland's Risk Management and Purchasing Department. The form serves as an audit checklist for evaluating contractor performance and compliance on city projects. The form includes sections for capturing basic project information such as contractor name, audit date, project title, and project location. The document contains an audit items section that evaluates contractors across multiple compliance and performance categories, with columns designated for audit results and supporting comments. One identified audit item includes EMR (Experience Modification Rate), which is a standard metric used in workers' compensation insurance assessment.

The form represents a standardized assessment tool designed to ensure contractors maintain compliance with city requirements and industry standards throughout project execution. While the specific audit criteria and scoring methodology are not fully detailed in the provided excerpt, the document's structure indicates that the City of Lakeland uses this systematic approach to monitor contractor performance on an annual basis. No specific pricing, set-aside provisions, incumbent information, or contract award details are addressed in this audit form, as it functions as an internal compliance and performance evaluation document rather than a procurement solicitation or contract award notice.

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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 .