Estimating Form Step 1 of 6 16% General Company InformationLegal Company Name* Physical Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Mailing address the same as physical address? Yes No Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Company Website Email* CRA Number* Years of Business Inception* Business Type* Corporation Limited Partnership General Partnership Sole Proprietor Limited Liablity Number of Employees* 1 – 5 6 – 10 11 – 25 26 – 50 51 – 100 100 + Principals, Directors, Officers and Key PersonnelList all Principals, Directors, Officers and Key Personnel involved*NamePosition# of years in current Position# of years with Company Use the + sign to add all required personnel Primary Contact InformationEstimator Name* First Last Estimator PhoneEstimator Email* HSE Main Contact Name* First Last PhoneEmail* Related Work ExperienceDescribe scope (s) of work performed*Does the Subcontractor perform any engineering, design or other professional services? Yes No Is any portion of this work subcontracted to others?* Yes No If Yes, Provide details:What percentage of the work is performed in the following industries?CommercialInstitutionalIndustrialResidentialGeographical Area(s) of Operations Northern AB Southern AB BC SK In the past (3) years, how many contracts have been completed within the following thresholds?< $100K$100K – $250K$250K – $500K$500K – $1M$1M – $2.5M$2.5M – $5M> $5M Work Experience / Project ReferencesProvide details of the largest contracts that have been completed in the past (3) years.Project NameLocationPM NamePM: Owner or Contractor?PhoneEmailContract ValueDate Completed Use the + sign to add additional completed projects Health and Safety ProgramDo you have a formal Health, Safety & Environmental Program?* Yes No Date last updated: MM slash DD slash YYYY Does the Subcontractor have a valid Certificate of Recognition (COR or SECOR)?* Yes No Have you ever been cited, charged, issued any OHS Orders or prosecuted for any OHS non-compliance or environmental offenses in the past 5 years?* Yes No If yes, provide details:Briefly explain any incidents of loss, damage or injury that resulted in loss time and/or an insurance claim and any steps taken to mitigate the cause of loss, damage or injury:Hazard AssessmentsAre daily and task specific hazard assessments performed on all worksites that identify jobsite health and safety hazards?* Yes No Are controls developed and implemented immediately?* Yes No If any of above elements are marked ‘No’, please explain:Inspections and AuditsDo you conduct health & safety inspections?* Yes No Frequency? Are workers involved in the inspection process? Yes No If no, why?Do you conduct health and safety program audits?* Yes No Frequency? Are corrections of the deficiencies documented? Yes No If no, why?Are inspection reports posted or communicated to workers?* Yes No If no, why?If any of above elements are marked ‘No’, please explain:Please check all applicable training provided to your workers and supervisors?* First Aid Safe Trenching, Excavation and Ground Dist. CSTS (Construction Safety Training System) ESTS (Electrical Safety Training System) Confined Space Entry & Rescue WHMIS H2S Prime Contractor Principles of Health & Safety Management Leadership for Safety Excellence Fall Protection Emergency Response Hazard Management Personal Protective Equipment Use, Care & Maintenance Asbestos Abatement Supervisory Roles and Responsibilities Other If other, please provide Quality Control ProgramDoes the Subcontractor have a formal Quality Control (QA/QC) Program?* Yes No If ‘No’, please explain:QAQC Contact Name PhoneEmail Bonding and InsuranceDoes the Subcontractor have a surety facility in place?* Yes No Name of Surety: Is a Letter of Reference from the Surety Company available? Yes No Is the facility secured by any financial and / or performance security? Yes No If yes, specify the type of security: Parent Company Guarantee Personal Guarantee Letter of Credit General Security Agreement Subordination Agreement Other If other, please explain: Has any claim been made against a bond provided on your behalf? Yes No If yes, provide details:Has a surety company ever declined to provide a surety bond?* Yes No If yes, provide details:Supplier Credit ReferencesList the names of the suppliers that extend credit to the Subcontractor.*Supplier NameContact NamePhoneEmail Use the + sign to add additional required referencesHas the Subcontractor, its shareholders or any related companies ever become insolvent or filed for bankruptcy?* Yes No If yes, provide details:Is the Subcontractor or any affiliated companies involved in any litigation, arbitration or mediation?* Yes No If yes, provide details:Have any liens been filed against the Subcontractor in the past (3) three years?* Yes No If yes, provide details:Has the Subcontractor or any affiliated companies ever failed to complete work under a contract?* Yes No If yes, provide details:Has the Subcontractor or any affiliated companies ever received a notice of default under a contract?* Yes No If yes, provide details:Acknowledgement of Information The undersigned certifies that the information provided herein is true and sufficiently complete so as not to be misleading.Name First Last Position Date MM slash DD slash YYYY Prequalification ChecklistHealth & Safety Program Manual. Drop files here or Select files Max. file size: 50 MB. Certificate of Recognition (COR or SECOR) Drop files here or Select files Max. file size: 50 MB. Quality Control Manual (if applicable) Drop files here or Select files Max. file size: 50 MB. WCB Employer Premium Rate Statement (last 3 years) & WCB Employer Report Card Drop files here or Select files Max. file size: 50 MB. Certificate of Insurance (General Liability and Automobile Insurance) Drop files here or Select files Max. file size: 50 MB. Current company organizational chart indicating project reporting structure Drop files here or Select files Max. file size: 50 MB. CommentsThis field is for validation purposes and should be left unchanged.
