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Bid Package 08 North Well Field - Garney Construction

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Colorado River Municipal Water District<br />

Ward County Water Supply Expansion Project – <strong>North</strong> <strong>Well</strong> <strong>Field</strong><br />

Attachment D<br />

CONTRACTOR’S SAFETY PERFORMANCE QUESTIONNAIRE<br />

<strong>Garney</strong> Companies, Inc. is dedicated to providing a safe and healthy work environment for its employees as well as our<br />

contractors and their employees working on our project site.<br />

Contractors proposing to provide services for the project must submit the following information for review. The questions<br />

below relate to the<br />

safety and health standards, including, but not limited to the Occupational Safety and Health Act of 1970 and the 29 CFR 1926<br />

Standards for <strong>Construction</strong>.<br />

This questionnaire has been developed by <strong>Garney</strong> Companies, Inc. to allow us to better understand your company's safety<br />

and health program and performance. The information submitted must be factual and verifiable. This information shall be<br />

used to determine eligibility of your company to perform services on this upcoming project. Your response / lack of<br />

response may result in disqualification from the evaluation process.<br />

Completion of this questionnaire in no way relieves your company of its obligation to comply with all applicable OSHA<br />

standards for the work your company may perform.<br />

1.0 Contractor Identification<br />

Legal Company Name: ________________________________________________________________ Date__________________<br />

Street Address_______________________________________________________________________________________________<br />

City:____________________________________________________ State____________________ Zip Code__________________<br />

Contact Name___________________________________________ Title:_______________________________________________<br />

Telephone:______________________ Fax:______________________ Email:___________________________________________<br />

<strong>North</strong> American Industry Classification System (NAICS) Code(s):_________________________________________________<br />

Confined Spaces Structural Steel Demolition Painting / Coatings<br />

Plumbing Excavation / Site Work Electrical Reinforcing Steel<br />

HVAC Yard Piping Surveying Drilling<br />

Concrete Tilt-Up Roofing Cast In-Place Concrete Masonry<br />

Misc Metals Carpentry Doors & Windows Insulation<br />

Paving (Asphalt / Concrete) Architectural Finishes Specialties Process Mech. Equipment<br />

Chemical Storage Tanks Instrumentation Elevators / Escalators Conveyors / Hoists<br />

<strong>Bid</strong> Proposal Form – <strong>Bid</strong> <strong>Package</strong> #8<br />

Colorado River Municipal Water District<br />

Ward County Water Supply Expansion Project – <strong>North</strong> <strong>Well</strong> <strong>Field</strong> BP - 16<br />

5/24/2012

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