HomeMy WebLinkAboutPantera Park - CONTRACTORS INDUSTRIAL SAFETY RECORD_S.Payan_BlueCollarContractors21
1293492.1
CONTRACTOR'S INDUSTRIAL SAFETY RECORD
Project Identification
Bid Date
This information must include all construction work undertaken in the State of California by the
bidder and any partnership, joint venture or corporation that any principal of the bidder
participated in as a principal or owner for the last five calendar years and the current calendar
year prior to the date of bid submittal. Separate information shall be submitted for each particular
partnership, joint venture, corporation or individual bidder. The bidder may attach any additional
information or explanation of data, which he would like, taken into consideration in evaluating
the safety record. An explanation must be attached of the circumstances surrounding any and
all fatalities.
ITEM 5 CALENDAR YEARS
PRIOR TO CURRENT YEAR
CURRENT
YEAR
2020 2021 2022 2023 2024 TOTAL
No. of Contracts
Total dollar amount
of
contracts (in 1,000’s)
No. of lost workday
cases
No. of lost work day
cases
involving permanent
transfer to
another job or
termination of
employment
No. of lost workdays
*The information required for this item is the same as required for columns 3 to 6, Code 10,
Occupational Injuries, Summary - Occupational Injuries and Illnesses, OSHA No. 102.
The above information was compiled from the records that are available to me at this time and I
declare under penalty of perjury that the information is true and accurate within the limitations of
these records.
______________________________ ________________________________
Name of Bidder (Print Signature
______________________________ ________________________________
Address State Contractor’s Lic. No. & Class
______________________________ ________________________________
City Zip Code Telephone
DIAMOND BAR
PANTERA PARK
02/27/2025
2
0
0
0
400,000
2
180,000
0
0
0
SEAN PAYAN
1939 N. VALLEJO WAY
UPLAND 91784 562-418-7580
984092