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5. SAFETY PROGRAM AND RECORD (15 POINTS) <br />Qualifications requirements C 5.1 and C 5.2 are PASS/FAIL. <br />The Respondent must not have had willful or repeated safety citations within the last 5 <br />years. The Respondent must answer both C 5.1 and C 5.2. Answering both questions is a <br />pass/fail requirement. Failure to meet the requirements stated here, or failure to answer the <br />questions, may be deemed to be non-responsive at the sole discretion of the City. If a <br />Responder is deemed to be non-responsive their response will be rejected. <br /> <br />5.1. Has the Respondent received from OSHA any willful or repeated safety citations for <br />which a final order has been issued within the last 5 years? (PASS/FAIL) <br />Yes No <br />**If yes, please attach document of willful or repeated citations. <br /> <br />5.2. Has the Respondent had any accidents which resulted in construction fatalities on any <br />of your construction sites within the last 5 years? (PASS/FAIL) <br />Yes No <br />If Yes, please provide details. <br /> <br />5.3. Experience Modification Rate (EMR): List your workersÓ compensation EMR for the <br />years indicated. Please attach document. <br />Policy Year 2023: Policy Year 2022: Policy Year 2021: <br />5.4. OSHA Violations: <br />Has the Respondent received one or more OSHA violations in the past 5 years? <br /> Yes No <br />**If yes, document all OSHA violations for your organization. (Add rows as necessary): <br />Inspection Date Inspection # State of Occurrence Number of <br />Violations <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Attach a copy of the violation(s) and describe in writing the actions you have taken to <br />correct the deficiency. <br /> <br /> <br /> <br />D-11 <br />Qbhf!324!pg!:15 <br /> <br />