2018 Contractor Application Form

Transcription

1 2018 Contractor Application Form 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 2018 Contractor Membership Dues Declaration 2018 Annual Contractor Dues (Schedule A Subtotal) HST (13%) TOTAL 2018 DUES 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 dues payment**

5 Schedule A 2018 Annual Contractor Dues 2017 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 1, Contractor 2 1,000,001 to 5 Million 2, Contractor 3 5,000,001 to 10 Million 5, Contractor 4 10,000,001 to 15 Million 6, Contractor 5 15,000,001 to 20 Million 7, Contractor 6 20,000,001 to 25 Million 8, Contractor ,001 to 35 Million 9, Contractor 8 35,000,001 to 50 Million 11, Contractor 9 50,000,001 to 75 Million 12, Contractor 10 75,000,001 to 100 Million 13, Contractor Million to 150 Million 14, Contractor Million to 200 Million 17, Contractor Million to 250 Million 19, Contractor Million to 350 Million 22, Contractor Million to 500 Million 24, Contractor Million to 750 Million 26, Contractor Million to 1 Billion 29, Contractor 18 1 Billion Plus 31,886.21

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 Membership Fee Schedule Description 2018 Membership Dues Subsidiary of an ORBA Contractor members (100% owned) which supplies products and services 1,565.00