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Bid Book - Dublin City, Ohio

Bid Book - Dublin City, Ohio

If craft "toolbox"

If craft "toolbox" safety meetings are held, what is their frequency? __ Weekly __ Bi‐weekly __Monthly __ Less often as neededDo you have a drug and alcohol testing policy? __ Yes __ NoIf Yes, attach a copy of the policy.Provide Contractor's OSHA No. 300 Log and Summary of Occupational Injuries and Illnesses for thepast five years.List all OSHA Citations and Notifications of Penalty, monetary or other, received within the last fiveyears: (Indicate final disposition as applicable. Attach additional sheets as necessary.)List all safety citations of violations under state law received within the last five years: (Indicate finaldisposition as applicable. Attach additional sheets as necessary.)SURETY AND INSURANCESurety Company: (Name and Address)Agent: (Name, Address and Telephone Number)Total bonding capacity: $ ________________________________________Limit per project:$ ________________________________________Available bonding capacity as of this date: $ ______________________CONTRACTOR FINANCIAL INFORMATIONList principal banks used, the approximate value of outstanding loans and general repaymenthistory, as well as the Name, Address and Telephone Number of a contact person:Attach audited financial statements for the past three (3) years, including latest balance sheet.State whether Contractor, or any of the individuals identified in Article 1, has/have been the subjectof any bankruptcy proceeding within the last five (5) years.__ Yes __ NoIf yes, describe circumstances on separate attachment.STATEMENT OF POTENTIAL CONFLICTS OF INTERESTProvide information about any business associations, financial interests or other circumstances thatmay create a conflict of interest with the City or any other Party known to be involved in theProject.5213‐006.0‐CIP

OTHER INFORMATIONWithin the past five years, has Contractor, or any of the individuals identified in Article 1 and/orSchedule A been the subject of any criminal indictment or judgment of conviction for any businessrelatedconduct constituting a crime under state or federal law? __ Yes __ NoIf yes, describe circumstances on separate attachment.Within the past five years, has Contractor or any of the individuals identified in Article 1 and/orSchedule A been the subject of any federal or state suspension or disbarment? __ Yes __ NoIf yes, describe circumstances on separate attachment.Within the past five years, has Contractor, or any of the individuals identified in Article 1 and/orSchedule A been the subject of any formal proceeding or consent order with a state or federalenvironmental agency involving a violation of state or federal environmental laws? __ Yes __ NoIf yes, describe circumstances. (Attach additional sheets as necessary.)REFERENCESProvide one additional reference for each of the following categories.1. CityName: ______________________Address: _______________________________Telephone No.: _____________________Contact Person: _________________________2. Architect/EngineerName: ______________________Address: _______________________________Telephone No.: _____________________Contact Person: _________________________3. SubcontractorName: ______________________Address: _______________________________Telephone No.: _____________________Contact Person: _________________________The Undersigned, on behalf of the Contractor, certifies under that the information provided here,or attached to this form, is true and sufficiently complete to the best of the Contractor’s knowledge.5313‐006.0‐CIP

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