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16. During the last five years, has your firm ever been denied bond credit by a surety company, or <br />has there ever been a period of time when your firm had no surety bond in place during a <br />project when one was required? <br />❑ Yes ❑ No <br />17. Has Cal -OSHA cited and assessed penalties against the contractor or its associates for any <br />"serious," "willful" or "repeat" violations of its safety or health regulations in the past five <br />years? <br />❑ Yes ❑ No <br />(Note: If you have filed an appeal of a citation, and the Occupational Safety and Health <br />Appeals Board has not yet ruled on your appeal, you need not include information about it.) <br />If "yes," on a separate page describe the citations, the party against whom the citation was <br />made, date of citation, nature of the violation, project on which the citation was issued, owner <br />of the project, and the amount of penalty paid, if any. State the case number and the date of <br />any OSHAB decision. <br />18. Has the Federal Occupational Safety and Health Administration cited and assessed penalties <br />against the contractor or its associates in the past five years? <br />❑ Yes ❑ No <br />(Note: If an appeal of the citation has been filed and the Appeals Board has not yet ruled, or <br />there is a court appeal pending, you need not include information about the citation.) <br />If "yes," on a separate page describe the citation, the party against whom the citation was <br />made, date of citation, nature of the violation, project on which the citation was issued, owner <br />of project, and the amount of penalty paid, if any. State the case number and date of any <br />decision. <br />19. During the last five years, has there been more than one occasion in which the General <br />contractor or its associates have been penalized or required to pay back wages for failure to <br />comply with the federal Davis -Bacon prevailing wage requirements? <br />❑ Yes ❑ No <br />If "yes," on a separate page, describe the violator, nature of each violation, name of the <br />project, date of its completion, the public agency for which it was constructed, the number of <br />employees who were initially underpaid and the amount of back wages and penalties that <br />were assessed. <br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED <br />Park Janitorial Maintenance Services RFP 14 -002 Page <br />38 <br />�XA <br />