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Bid List Application

Step 1 of 6

16%

General Information

Business Address(Required)

You can select up to six (6) Trades

Primary Contact Information

Primary Contact - 1

Name(Required)
Address(Required)

Primary Contact - 2

Name(Required)
Address(Required)

Primary Contact - 3

Name(Required)
Address(Required)

Bidder Information

Bidder Information

Safety Information

Current experience modifications rate (EMR) (Obtained from insurance carrier) rates

Please enter a number from 2020 to 2025.
Please enter a number from 0.5 to 2.
Please enter a number from 2020 to 2025.
Please enter a number from 0.5 to 2.
Please enter a number from 2020 to 2025.
Please enter a number from 0.5 to 2.

OSHA 300 Log Information

Please enter a number from 0 to 999.
Please enter a number from 0 to 999999.
Please enter a number from 0 to 999.
Please enter a number from 0.5 to 2.
Please enter a number from 0.0 to 999.9.
Please enter a number from 0 to 999.
Please enter a number from 0 to 999999.
Please enter a number from 0 to 999.
Please enter a number from 0.5 to 2.
Please enter a number from 0 to 999.
Please enter a number from 0 to 999.
Please enter a number from 0 to 999999.
Please enter a number from 0 to 999.
Please enter a number from 0.5 to 2.
Please enter a number from 0 to 999.

OSHA 30 certified personnel

OSHA 100 certified personnel

Safety Questionnaire

Does your company have a qualified person responsible for safety within your company?(Required)
Does this person do safety inspections on all of your projects?(Required)
How often are these inspections?(Required)
Has your company ever implemented 100% fall protection?(Required)
If requested, can you provide us with a site-specific program addressing the fall hazards in your company's work?(Required)
Does your company have a written company safety policy and program and will you provide copies if requested?(Required)
Does your company require documented safety meetings for your employees?(Required)
How often are these safety meetings?(Required)
Does your company provide safety training for all employees?(Required)
Does your company set annual safety training goals?(Required)
Does your company have a program recognizing your employees for safety excellence?(Required)
Does your company have a disciplanary program in place for safety violations?(Required)
Does your company conduct accident/incident investigations?(Required)
Does your company have a substance abuse policy?(Required)
Please indicate which are included in your policy(Required)
Does your company have a return to work/light duty program?(Required)

Insurance Information

Does your carry workers' compensation insurance?(Required)
What is the expiration date?(Required)

Additional Attachments

Drop files here or
Max. file size: 300 MB, Max. files: 10.

    Signature

    We have attempted to answer all questions in a full and complete manner to assure that our answers are not in any respect misleading, either by expressing ourselves in a misleading or ambiguous manner or omitting information. We recognize that MV Commercial Construction will be relying on the accuracy of the information and our responses in this questionnaire in deciding whether to permit us to bid and in awarding work to our Company.

    Date(Required)
    info@millervalentine.com US Toll Free: 877 684 7687
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