PSM_-_Contractor_Audit_Form.pdf

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Attached to
ANNUAL 69KV CIRCUIT BREAKER MULTI-YEAR AGREEMENT
Solicitation number
2026-ITB-127
Issued by
Polk County, Florida

About this file

This is a Contractor Audit Form from the City of Lakeland, Risk Management and Purchasing department, used to evaluate contractor performance and compliance on city projects. The form serves as an assessment tool for the City of Lakeland to audit contractors operating under municipal contracts, including those related to specialized procurement agreements such as the Annual 69kV Circuit Breaker Multi-Year Agreement. The audit form documents contractor information, project details, location, and various audit items with corresponding results and comments sections to track contractor compliance and performance metrics.

The related contract opportunity is a one-year agreement for the purchase of 69kV circuit breakers with options for four additional one-year renewals, not to exceed five years total. The specification calls for three-phase, 60 Hz outdoor circuit breakers rated for 72.5 kV maximum line-to-line voltage with 2000A capacity and either 48VDC or 125VDC configurations. The breakers must feature dead tank construction with sulfur hexafluoride gas and/or vacuum as the dielectric and interrupting medium, designed for three-pole gang tripping and closing on solidly grounded systems. The contract is available for use by other City of Lakeland departments as applicable, with purchase orders referencing specific part numbers and technical specifications for the required circuit breaker units.

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Text version

RISK MANAGEMENT AND PURCHASING REVISED 04/01/2026

City of Lakeland, Risk Management and Purchasing RMP- Contractor 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 .