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Appendix <br />ATTACHMENT 4 <br />INDUSTRIAL SAFETY RECORD (FORM) <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS <br />FOR <br />ON -CALL TRAFFIC CONTROL SERVICES <br />RFP NO.: 19-117 <br />(To be Completed and Submitted with Contractor's Proposal) <br />Number of OSHA Violations within the last 5 years (must state zero if none): <br />0 Serious 0 Willful o Repeat 0 Other 0 Unclass 0 Total <br />California Barricade, Inc. <br />Firm Name (Print) <br />Signature <br />Kellie Hurst Vice President <br />Name and Title (Print) <br />November 25, 2019 <br />Date <br />City of Santa Ana RFP 19-117 <br />2'8EA27 <br />