2019 Contractor and Producer Member Application Form (Schedules A & B)

Transcription

1 2019 Contractor and Producer Member Application Form (Schedules A & B) Company Name COMPANY INFORMATION Year Established Company Address City/Town Postal Code Phone Fax Website Name of Parent Company or 100% owned subsidiary contractor, address and contact details List Branches/Offices COMPANY MAIN CONTACT Company Owner/President/CEO Address Contact Number COMPANY KEY CONTACTS Company Officers (Name and Title) Address Please indicate if a key contact

2 CONSTRUCTION ACITIVITY State major types of construction activity, including construction and design of roads and highways, bridge construction, road maintenance, sewer and water main, public transit, tunnels, culverts, viaducts, excavation, airports, golf courses, marine general heavy construction or other. COMPLETED PROJECTS Please list three (3) recently completed projects Include name of project, owner contact and work involved Contract Value REFERENCES (ALL FIELDS REQUIRED) BANK NAME BRANCH ADDRESS ORBA/OAPC MEMBER COMPANY (minimum one contact required) CONTACT PERSON PHONE AND ADDRESS MEMBERSHIP IN OTHER INDUSTRY ASSOCIATIONS (please list if applicable)

3 Declarations I [insert name], [insert title], of [insert company] HEREBY AGREE the following statements regarding the company applying for membership are accurate and true; whether incorporated or unincorporated, is actively engaged in Ontario as a provider of services, machinery, equipment or supplies to ORBA members, has minimum two years, uninterrupted, operating experience, has no history of bankruptcy, fraud or similar breaches for the last three years, is in compliance with all applicable laws, rules and regulations, including but not limited to, health and safety and environmental, and be duly qualified and licensed to do business in each jurisdiction which requires such qualification or licensing, maintains General Liability Insurance with a minimum of CAD5 million coverage, underwritten by a reputable insurance company, will adhere to the ORBA Code of Ethics and By-Laws, and will submit dues and other payments on a timely basis. HEREBY AGREE, that upon becoming a member, ORBA has consent to send s to the contacts listed in the application. HEREBY AGREE, that ORBA has express permission to conduct references with the referees provided above. Authorization Authorized Applicant Signature Date of Application Payment Upon internal review of application, a formal invoice will be issued based on annual fees Applications received after March 31 will be subject to quarterly prorated fees Applications received between October December, will be subject to final quarter fees as well as following year s annual dues

4 2019 Contractor and Producer Member Fees Declaration 2019 Annual Contractor Fees (Schedule A Subtotal) 2019 Asphalt Producer Fees (Schedule B Subtotal) HST (13%) TOTAL 2019 FEES SUBMITTED The undersigned hereby verifies they are a corporate signing officer of the Company and that the above information is true and accurate. Name (please print) Signature Company Date **Please remit with fees payment**

5 2019 Annual Contractor Dues (Schedule A) 2018 CIVIL CONTRACTING VOLUME: CONTRACTOR CATEGORY: CATEGORY Annual Civil Contracting Volume (Parent Company Plus Subsidiary Companies) Annual Contractor Dues Subtotal Contractor 1 Less than 1 Million 2,009 Contractor 2 1,000,001 to 5 Million 2,537 Contractor 3 5,000,001 to 10 Million 5,716 Contractor 4 10,000,001 to 15 Million 6,723 Contractor 5 15,000,001 to 20 Million 7,706 Contractor 6 20,000,001 to 25 Million 8,898 Contractor ,001 to 35 Million 10,103 Contractor 8 35,000,001 to 50 Million 11,370 Contractor 9 50,000,001 to 75 Million 12,637 Contractor 10 75,000,001 to 100 Million 13,890 Contractor Million to 150 Million 15,143 Contractor Million to 200 Million 17,649 Contractor Million to 250 Million 20,155 Contractor Million to 350 Million 22,660 Contractor Million to 500 Million 25,166 Contractor Million to 750 Million 27,672 Contractor Million to 1 Billion 30,178 Contractor 18 1 Billion Plus 32,683

6 Annual Civil Contracting Volume Volume is defined as total dollars paid/expected in the immediate past membership year (2017) on public owner projects (as a contractor, sub-contractor or through subsidiary operations) within Ontario for all types of transportation infrastructure including construction of, and components of, roads, highways, bridges, transit, rail, airports and marine transport and maintenance. The volume payment is based on total annual payments and includes all project costs (i.e. supplies and sub-contractor costs). Includes parent company, plus 100% owned contractor subsidiary companies. Associate Member CATEGORY Associate Associate Member Fee Schedule Description 2019 Membership Dues Subsidiary of an ORBA Contractor members (100% owned) which supplies products and services 1,604

7 2019 Asphalt Producers Fees (Schedule B) 2017 Producer in Tonnes x 1,000 Mid-Way Point A + B = C Mid-Point for 2017 Base Fee Production (or Exact Tonnage)* Sub-total , , ,009 1,352 3, ,009 2,704 4, ,009 5,070 7, ,009 8,450 10, , ,009 11,289 13,838 1,000-1,500 1,250 2,009 16,900 18,909 1,500-2,000 1,750 2,009 23,659 25,668 2,000-3,000 2,500 2,009 33,799 35,808 3,000-4,000 3,500 2,009 47,312 49,321 4,000-5,000 4,500 2,009 60,839 62,848 5,000 plus 2,009 70,673 77,682 IMPORTANT: The Producer s production number or category will be kept in the strictest confidence by the Chief Operating Officer. *If choosing to submit in Exact Tonnage, please enter that amount in row B below A = Base Fee 2,009 B = Tonnage midpoint or exact C = Schedule B Sub-total