Did someone at SRG request you to complete this form? If so, name:
Do you require SRG to complete your Company credit application?
(if “yes”, attach your credit application for SRG’s execution. Please be advised that no T&C’s will be entertained by SRG in the credit application, payment or other terms shall be subject to each individual Purchase or Subcontract Order).
Have you worked for SRG in the past year?
Are you deemed by CRA to be a ‘Subcontractor’ pursuant to line 295 of the T5018?
Thank you for your interest in becoming a Site Resource Group Inc., Bears Access and Environmental Inc., Site Equipment Ltd., and/or Force Copps Piling Inc. (together “SRG”), 3rd Party Supplier.
At SRG, our due diligence requirements set out by our Contracts Center of Excellence (“CCOE”), mandates that we evaluate all 3rd Parties engaged in our supply chain. In efforts to fulfill our commitment, we must understand the processes, culture and business acumen of our 3rd Parties.
Once prequalified, SRG will require updated questionnaire information annually, and updated insurance information as the current coverage expires. All submissions shall remain “for internal use only” at SRG, and will not be provided to external sources.
The prequalification process does not preclude requests for additional information as designated by projects and/or specific work sites.
We appreciate the time and effort you’ve taken in providing accurate information to SRG. Please note that completion of this questionnaire, including gathering documentation and/or related communications does not constitute work for SRG, and therefore this task is not billable.
Please note the completion of this questionnaire is MANDATORY regardless of supply type. However, based on supply type, some Sections may not be applicable to every 3rd Party Supplier, resultantly please read the instructions in each section carefully. Once complete, please email this completed form along with the required verification documents to: Vendors@siterg.com
All required questions must be answered and details provided as requested. Incomplete responses or missing information may result in delay of the approval process, or in rejection of your submittal.
If a subsection or specific question is not applicable to your business, please mark as “N/A”. Where
“N/A” is set out as your response, you may be contacted by an SRG representative, for further clarification.
Do you perform any of the following Critical tasks? (Check any and all that apply). If none apply, please leave blank, if they apply the title “Subcontractor” shall be assigned to your firm:
Confined Space EntryLifting Operations or Material HandlingWater or Ice Working EnvironmentsMobile/Heavy Equipment OperationsHazardous Materials & Environments*Project or Construction oversightAerial or Marine WorkFabrication or ManufacturingHot WorkWorking at HeightsTraffic Conditions, Traffic Controls & TransportDrilling OperationsSecurity or FirearmsHazardous Energy (including Lockout/Tag out and/or Electrical)Use of Regulated Equipment e.g. nuclear gaugesNoxious flora/aggressive fauna controlsEngineering or Design ServicesActivities on a construction site that require your personnel in attendanceAgent, Broker, or ConsultantGround Disturbance to any level (includes Utility Locates and Excavation as examples)
*e.g. asbestos, unoccupied buildings, construction, hazardous waste, live energy, active traffic zones, etc.
SERVICES, EQUIPMENT &/OR PRODUCT TYPICALLY PROVIDED TO SRG:
Please check off all the commodities that apply to your company in this table.
Sections 1-8 & 10 apply.
*Exemptions to Section 9 (QAQC) may be granted for those italicized commodities.
ON SITE WORKS
*Aerial Works;Architectural;enterBuildings;Civil Works;Cleaning – Industrial (Chemical/Steam);Coatings;*Communications;Concrete (precast/structural);Concrete (pre-stress/post tension);Cranes, Monorail, Bridge, Polar;Construction Services;*Consulting;*De-Watering;Doors, Industrial, Fire;Drilling;Ductwork, Conventional Sheet Metal;Ductwork, Heavy Gauge Metal;Electrical Construction – General Contractor;Electrical Construction – Outside (pole line);Electrical Construction – Transmission;*Environmental Services;*Fencing;Fire Protection;Flow-lines;Foundations, Equipment Setting;Geomatics;Heat Treatment/Stress Relieve (on site);Heating, Ventilation, Air Conditioning (HVAC);Heavy Haul/Lift, Rigging;Hydro-testing;*Hydro-Vac;Instrument and Controls, DCS;Inspection/Testing;Insulation – Materials, Thermal, Wallboard;Insulation – spray on;Insulation – Thermal, Conventional;*Janitorial;*Labour Broker;Marine;Mechanical;Mechanical Fabrication;Module Erection;*Module Accommodation or Camp;Maintenance;Manpower & Resources;Piling;Piping;Piping Fabrication;Pipeline;Pressure Vessels;Protective Service;Service Work;Siding – Fibreglass;Siding – Metal;Specialty Services (describe below);Startup Assistance, Testing, Training;Steel Fabrication;Structural;Surfacing Membranes for Roads, Tank Farms;Survey, Aerial Mapping and Photography;Tankage, Bins, Fiberglass - Plastic;Tankage, Bins, Silos – Concrete;Tankage, Bins, Silos – Metal;Tankage, Pads and Dykes;*Temporary Facilities (temp. power, propane, potable-water, septic services);Testing, Chemical Analysis;Testing, Nondestructive Examination for Piping;Transport (Gravel Only);Transportation;Underground Utilities;Walls, Curtain, Glass, Aluminum;Welding
Vendor Type A
Sections 1-9 & 10 apply.
*Exemptions to Section 8 (HSSE) apply.
OFF SITE WORKS
*Crushing/Screening (process plant);*Design or Engineering;*Electrical Switchyards;*Steel Supply;*Testing, Soil, Concrete – Destructive
Vendor Type B
Sections 8 & 9 (HSSE & QAQC) are exempt for all commodities in this section.
OFF SITE WORKS and NON-QUALITY SENSITIVE SUPPLY
Air Travel;Banks/Financial Institutions;Consumables;Department Stores;☐Drug (safety) Testing;Equipment Rental;Equip. Parts or Maintenance;☐Fuels/Lubricants;Government Firms;Gravel Supply;Hotels;Insurers;Landlords;Law Firms;Office Supplies;Restaurants;Safety Supplies;Signs;Small Tools;Software;Tax Authorities;Training (off site);Utility Providers
(IF COMMODITY IS NOT LISTED ABOVE)
GENERAL COMPANY INFORMATION
Company’s Legal Name:
(list all companies applicable)
Jurisdiction of Registration:
Registration (Tax ID #):
Registration Expiry Date:
Alternate Trade or Business Name (doing business as):
Are You a Publicly Traded Company?
Ticker Symbol or equivalent:
Please indicate which of these best describes your business:
Individual/Sole ProprietorshipPartnershipCooperativePublically Traded CorporationPrivate CorporationLimited Liability PartnershipPublicly Owned CompanyOther
If “Other”, please specify:
Please indicate which of these best describes your business structure:
Simple Company StructureCanadian SubsidiariesOverseas SubsidiariesJoint VentureConsortia
Please indicate which of these best describes where your business operates?
Single site in CanadaMultiple sites in CanadaWorking in USAGlobal
City/Town & Province:
How many years has your organization been in business?
Is your business required to be registered with any governmental or other organization in order to provide services?
If “yes” please list:
Does your Company participate in Indigenous cultural awareness training programs?
Please indicate if applicable:
First Nation,Metis,Inuit,Other Minority Group,N/A
If “Other Minority Group”, explain:
What % of Indigenous ownership, if any, does your Company have:
EFT remittance email address:
List of goods/services/equipment normally provided by your company, that you may contract to others:
Insurance and Worker’s Compensation are required as part of SRG’s prequalification process.
WORKERS’ COMPENSATION INFORMATION
Does your company have Worker’s Compensation Coverage?
WCB Account Number (Code & Classification) – BC:
WCB Account Number (Code & Classification) – AB:
WCB Account Number (Code & Classification) – SK:
WCB Account Number (Code & Classification) – MB:
WCB rates for the previous 3 calendar years:
Industry Base Rate
Your Company’s Experience Rate
% Discount or Surcharge
Is your Account in Good Standing?
Attach the following:
Provincial WCB - Employer Premium Rate Statements; and
Provincial WCB - Letter of Good Standing.
(attach for each jurisdiction applicable to your company)
Please note three (3) years’ worth of rate letters will be assessed and must include current year – ensure this is adhered to when submitting your documents.
GENERAL BUSINESS INSURANCE
Name of Insurance Broker:
For specifics on coverage – See EXHIBIT A (Insurance Requirements).
Please ensure you attach a copy of your current COI. It must name “Site Resource Group Inc., Bear Access & Environmental Inc., Force Copps Piling Inc. @ 170, 120 Pembina Rd., Sherwood Park, Alberta, T8H-OM2” as an additional insured.
Please answer all questions to the best of your knowledge.
Does your company have a Compliance Officer (or equivalent)?
Does your company provide compliance and anti-corruption training to employees?
Does your company have a Code of Conduct or specific anti-corruption policies in place? If “yes”, please include a copy.
Does your company agree to comply with the SRG Code of Business Conduct Policy and the SRG Anti-Bribery & Corruption Policy?
During the past five (5) years have you, your company or any Board of Directors, Key Officers, Key Employees or Beneficial Owners (as applicable), been the subject of any actions resulting from suspension, debarment, or disqualification?
* Have you, your company or any Board of Directors, Key Officers, Key Employees or Beneficial Owners (as applicable) ever been charged or convicted of any financial crime, fraud, or corruption-related offense?
During prospective work with SRG or the services offered, do you/your company anticipate any interaction with government employees? (including, but not limited to, interaction with licensing agencies, customs officers, and local tax authorities)
* Are you or any of your Board of Directors, Key Officers, Key Employees or Beneficial Owners currently, or have they been in the last year, a government employee pursuant to the services you will be providing to SRG, or do they currently have close family ties with a government employee involved with the services to be provided?
* Have you/your company, or any Board of Directors, Key Officers, Key Employees or Beneficial Owners (as applicable) been or currently employed by a separate entity affiliated with another party to any transaction relating to the services?
* Have you/your company or any affiliates or partner firms or individuals paid or are they going to pay any governmental official any compensation or fee in connection with the awarding or oversight of any services to be provided or anticipated?
* Do you/your company intend to pay, directly or indirectly, any commission or finder’s fee to a third party or agent relating to the services?
If no, what is your position on this?
HUMAN RIGHTS, TRAFFICKING, AND MODERN SLAVERY
Does your company protect human rights?
Does your company prohibit human trafficking and modern slavery?
Social Accountability Certification
Are you certified for Social Fingerprint (click for more information)
If yes, please provide a copy of your current certification, including a summary of any recent audits to ensure compliance with the SA8000 standard.
On behalf of company, I attest and certify, in connection with our engagement to provide goods, equipment or services to Site Resource Group Inc., its subsidiaries and its affiliates (“SRG”), that I have received a copy of the SRG Business Ethics & Conduct Policy and its Anti-Bribery & Corruption Policy (“SRG Policies”), and I have read and understood its provisions, and am authorized to sign this certification individually and on behalf of the Company. Resultantly, I hereby covenant and agree that all Company persons (including lower tier subcontractors) providing by company to SRG, shall: (i) be advised of the SRG Policies; (ii) such parties shall comply with SRG Policies in addition to any such applicable laws in the jurisdiction; (iii) affirm that no commissions, or any other money or thing of nominal value has been or will be paid, offered, given promised or authorized directly or indirectly by Company to any Government Official and/or target Customer for the purpose of influencing any act, inaction or decision of such person, securing an improper advantage from such person, or inducing any such person to use their influence with Government and/or target Customer to affect or influence any such act or decision of such Government or target Customer; (iv) will keep complete and accurate records that fairly reflect the transactions and expenses related to the Company business and the records shall state in reasonable detail the purpose of each expense and the receipt and distribution of the asset; and finally (v) Company agrees that if future developments cause the representations and certifications provided herein to no longer be accurate or complete, it will promptly send SRG a written report detailing the causes and extent of the changes.
I AGREEI do NOT Agree
Please be advised that prior to first payment, your Finance Representative set out in Section 4, shall receive a phone call to verify banking details from a SRG Finance Representative.
Does your Company have audited financial statements?
If yes, and you have done more than $2M in work with SRG in the past calendar year, please provide copies for the last 3 financial years.
$ Value last calendar year:
Company’s books and records maintained in accordance with your country’s standards or internationally accepted accounting standards?
Financial Volumes: Annual billings for the last three years
Equity / LOC Available:
Banking Information – CANADIAN
NOTE: Please provide a void cheque or bank issued document, endorsed by your bank.
Bank Phone Number:
Transit No.: (5 Digits)
Bank ID No.:(3 Digits)
# of Yrs with Bank:
IF APPLICABLE – International Wire Payments
NOTE 1: Please provide additional intermediary bank details, if used by beneficiary (vendor) for international payments. If banking information differs for payment in non-CAD currency, please provide details.
NOTE 2: Please provide a void cheque or bank issued document endorsed by your bank.
Beneficiary (vendor) name and address:
Beneficiary Bank Name:
Beneficiary Bank Address:
Swift Code / BIC:
If necessary, please provide other bank references on a separate sheet.
*Company hereby authorize and direct that all payments due to the Company from SRG shall be directly deposited into the above named bank account. We agree that SRG will not be liable for any loss occurring after the deposit has been made to the identified bank account. We also agree that any duplicate payment, overpayment, fraudulent payment made in error will be promptly returned to SRG. We acknowledge and agree that it is our responsibility to provide correct information.
Name of Surety Company:
Available Bonding Limits
Performance & Labour Bond:
Material Payment Bond:
List all Owners (Companies or Individuals) of Company.
Ownership percentages must total 100%
Please provide the names of each legal and beneficial shareholder, together with a list of any majority or controlling interest in any other Company. If publically traded list each shareholder holding 5% or more individually.
Also, list all companies owned or controlled by Company.
Please provide a detailed list of any subsidiaries or parent company including registered number, country of registration and % of subsidiary owned.
Where possible please also provide the details in the form of a group structure chart.
Do you have ownership/affiliates?
BOARD OF DIRECTORS
Please list all Members of the Board of Directors and all Officers of your company.
“Key Employees”: anyone with managerial responsibility (e.g. Director, CEO, or CFO) and any other employee with decision-making authority relevant to site products or services or involved with projects involving site products or services;
Does your company have an export control and sanctions program?
Does your company check designated persons lists for entities with whom the contract or supply (i.e. the end or actual users)?
What other diligence and background checks are carried out by your company prior to entering into contracts? Please provide details below.
Please provide details below of all freight forwarders used by your business.
Please provide a list of three (3) recent project references as set out below:
Has your company ever failed to complete a contract awarded to you?
Has your company ever evoked its lien rights?
If yes, please explain:
Are there any judgements, claims or suits pending or outstanding against your company?
If “yes”, please provide details:
Are you now, or have you ever been involved in any bankruptcy or reorganization proceedings?
If “yes”, please provide details:
Number of permanent employees:
Please describe any affiliations with labour organizations:
Please list all trade agreements or labour contracts that your company or any affiliate is a signatory to (include expiry dates):
*Please submit a copy of your Annual RATE schedule, if applicable ☐attached ☐not attached
SAFE WORK PERFORMANCE
Injury Experience / Historical Performance for the Company
Use the current and previous 3 years injury and illness records to complete the following:
# of Medical Treatment Cases:
# of Restricted Work Day Cases:
# of Lost Time Injury Cases:
# of fatal injuries:
Total Recordable Injury Frequency:
Lost Time Injury Frequency:
# of man-hours:
“Medical Treatment Cases” any occupational injury or illness requiring treatment provided by a physician or treatment provided under the direction of a physician.
“Restricted Work Day Cases” any occupational injury or illness that prevents a worker from performing any of his/her craft jurisdictional duties.
“Lost Time Injury Cases” any occupational injury that prevents the worker from performing any work for at least one day.
“Total Recordable Injury Frequency” is the total number of Medical Treatments, Restricted Work Day Cases and Lost Time Injury Cases multiplied by 200,000 divided by total man-hours.
“Lost Time Injury Frequency” is the total of Lost Time Injury Cases multiplied by 200,000 then divided by total man-hours.
*PLEASE PROVIDE A DESCRIPTION OF ANY LOST TIME INJURIES OR FATALITIES IDENTIFIED ABOVE.
Do you have a full-time dedicated Safety representative?
Has your HSSE Management System been evaluated using an industry recognized audit within the last three (3) years? Examples include: COR/SECOR, OHSAS 18001, ISO 14001, ISRS.
(if yes, please provide copy of certificate and most recent audit summary)
H&S Inspections and Audits
Explain your company’s process for investigations; including any root cause analysis techniques
How are incidents reviewed to prevent future occurrence?
ORDERS AND CITATIONS
Has your company been cited, charged or prosecuted under the Alberta Occupational Health and Safety Act or the Alberta Environmental Enhancement and Protection Action (or such other legislation applicable in the jurisdictions worked), in the previous 3 years?
Has your company ever been barred from working on any site, or been required to stop work due to an HSSE violation?
If “yes”, provide details:
In the past three (3) years, has an OH&S or Environmental Regulator ever had cause to investigate your worksite? (not including regular inspections)?
In the past three (3) years, has an OH&S or Environmental Regulator issued orders or citations against your company for HSSE violations?
Do your company have a written safety program manual?
If “yes”, provide an electronic copy.
Does your safety program contain the following elements:
Rules & Regulations
Awards & Recognition
Safety Inspection & Audits
Training & Competency
Meetings & Communications
Roles & Responsibilities
Records, Stats & Document Control
Incident Reporting & Investigation
Drug & Alcohol Program
Bullying / Harassment
Can your company demonstrate that your employees have the required competencies for specific functions or high-risk tasks?
If “yes”, please provide a copy of the procedure used.
Understanding of training is verified by:
Written Test;Oral Test;Performance Test;Performance Test;Mentoring;Other
If ‘other’ please specify:
ORIENTATION & TRAINING PROGRAMS
HSSE Orientation Program
Do you have a HSE Orientation Program for new hires as well as newly hired or promoted supervisors?
Does the ORIENATION Program include the following:
General Rules & Regulations
Right to Refuse Work
Personal Protective Equipment
Ladders & Scaffolds
Fall Arrest Standards
Aerial Work Platforms
Confined Space Entry
Trenching & Excavating
Signs & Barricades
Cranes & Rigging
Hand & Power Tools
Fire Prevention & Protection
Compressed Gas Cylinders
Does your program for training newly hired or promoted SUPERVISORS include instruction of the following:
Safe Work Procedures
First/Aid Medical Procedures
New Worker Training
Pre-Job Safety Instruction
Drug & Alcohol Policy
Progressive Disciplinary Policy
Safe Work Practices
Note: Please attach with your submission your orientation and supervisor training documents.
Do you conduct safety inspections?
If “yes”, what frequency?
Does your safety inspection process include:
Follow-Up to Corrective Actions
Report Distribution Requirements
Does your company hold site safety meetings for field employees?
If “yes”, how frequently?
Does your company hold contractor meetings where safety is addressed with Management and Field Supervisors?
Is Pre-Job safety instructions provided before each new task?
Is the process documented?
Who leads the discussions:
Does your company have a hazard assessment process?
Does your company have a field level hazard assessment at the worker level?
Does your company have a process for evaluating higher risk activities?
Does your company have a continuous improvement process for HSSE including the following?
HSE Action Plans
Safety Alerts & Formal Company Wide Communications
Annual Safety Goals
Fit For Duty Program
HSSE PROGRAMS, PRACTICES AND STEWARDSHIP
Are incident reports and report summaries set to the following persons, and how often?
Project / Site Manager
Safety Director / Manager
How are incident records and cost summaries kept? (e.g.: by project, by region, etc.)
How often are incidents reported internally?
Does your company track non-injury incidents?
How often are they summarized and communicated, in particular as follows:
HSSE COMMERCIAL QUERIES
Do your employees have ready access to the OH&S Legislation?
Does your waste management system identify and address all the Provincial, Territorial, Local and Federal Governmental regulations required for the disposal of any hazardous wastes?
Does your company have written programs for WHIMIS/HAZCOM including MSDS/SDS for all controlled products?
Does your company review monthly Carrier Profiles?
Does your company monitor driver’s hours of work and conduct log book monitoring?
Is each of your workers’ required HSSE training and retraining current?
Does your company HSSE program included the following:
Compressed Gas Handling
Driving and Journey Management
Confined Space Entry
Fit for Duty (e.g. fatigue, illness, physical limits, focus, impaired, etc.)
Alcohol and Drug (include copy of policy or practice)
Working at Heights
Mechanical Hoisting and Lifting
Working with H2S (hydrogen sulfide)
Lockout, Tag Out
Heat Stress / Cold Stress
If required by legislation or work scope, do your employees have medical examinations for:
(please select N/A only if not required)
Pulmonary Function Testing
Does your company have written work practices for the following?
Hearing Conservation Testing
If respiratory protection is required, have employees been:
- Mask Fit Tested
- Trained in use of Respiratory Protection Equipment (RPE)
- Medically approved for Class A&B chemical suits with use of RPE
Personal Protective Equipment (PPE)
Does your company provide applicable PPE to employees?
Does your company have a program to ensure PPE is inspected and maintained?
Are employees trained in the use, care, and limitations of PPE?
Does your company have a preventative maintenance program for your equipment?
Does your company have maintenance staff and/or use an external maintenance provider?
(if no subcontractors are involved, mark N/A and skip this section)
As part of the selection process, does your company evaluate the ability of subcontractors to comply with applicable HSSE requirements?
Does your company monitor subcontractors HSSE performance at the worksite?
If “yes”, please describe how this is accomplished
Does your company include your subcontractors in:
KEY QA/QC PERSONNEL
*Please provide a copy of your organizational chart showing functional reporting of your quality department (Corporate, Site & Supervision). Is it attached:
Does your Company have dedicated Quality Assurance / Control personnel in the following positions?
Quality Control and Quality Assurance Manager
Field Quality Lead
Document and Records
Warehousing and Receiving
Do you have an approved quality control manual (ABSA, TSASK, etc)?
If “yes”, provide an uncontrolled copy in PDF format.
Do you have a Quality Management System Manual (ISO)?
If “yes”, provide an uncontrolled copy in PDF format.
Is your company ISO Certified or ISO ready?
If so, indicate the Quality Management System:
ISO 9001;ISO 9002;ISO 9003;
Name of ISO Registering Body:
Expiry date of current Registration:
Does your company have a documented quality policy or a quality statement?
Are your employees motivated to achieve the defined quality objectives?
If “yes”, can you provide an example?
Does your QMS system include provisions for the use of project quality management plans (PQMP)?
Does your QMS process employ the use of an inspection and test plan (ITP)?
Does your quality manual cover the following procedures?
ITP development and implementation
Receiving and material inspection
Packing, storage and handling
Internal auditing process
Records and document control and retention
How often do you revise your procedures, quality manuals, and other controlled documents?
NeverAnnuallyEvery 2 yrs.As required
STANDARDS AND CERTIFICATION
List codes and standards to which your company is qualified (ASME, API, ANSI, CSA, ASTM, CGSB, etc.) Include any sections/divisions e.g. CSA 47.1 Divn 2.1.
Do you have a documented procedure for purchasing of materials?
Do your PO’s contain material type, class, grade, colour code, inspection documents, receiving, preservation, maintenance, specification requirements?
Do you confirm the material specifications with test certificate copies, prior to release to construction?
Do you maintain a list of approved suppliers?
SUPPLIER QUALITY CONTROLS
Does your company perform a quality audit on its suppliers prior to use to evaluate their ability to supply acceptable material/product?
Does your company perform quality surveillance on your suppliers?
If “yes”, how frequently?
If surveillance and quality audits are performed, are the results available to SRG for review?
Are PO’s reviewed by your quality group for compliance to specifications and drawings prior to processing?
SIGNING THIS DOCUMENT IS CONFIRMATION THAT YOU HAVE SHARED THE REQUIREMENTS HEREIN WITH THE EMPLOYEES OF YOUR ORGANIZATION WHO WILL BE WORKING FOR AND ON BEHALF OF SRG, AND THAT THE INFORMATION YOU HAVE SUPPLIED IS BOTH ACCURATE AND TRUTHFUL.
I declare that the information provided on this questionnaire is true and correct to the best of my knowledge, and open to review by SRG.
Company agrees that, in order to be considered for supply to SRG (or its subsidiaries, segments or affiliates), Company must provide certain information to SRG. Company therefore agrees and consents, as a condition to its being considered for supply to SRG, to the following:
Company agrees and consents to the release to SRG, or to third parties retained by SRG to conduct investigations on its behalf, of information possessed or maintained by information sources about and concerning Company (hereafter “information sources”) which serves to support, verify or qualify answers to inquiries set forth in SRG’s 3rd Party Qual. Questionnaire Application.
Such information sources will include, but are not limited to, entities with which Company maintains banking or other financial relationships, business references provided by Company, governmental or regulatory agencies and which Company has had dealings, contacts or affiliation.
By signing this document in the space set forth below, Company further agrees:
that any and all said information sources may completely and unqualifiedly on said signature of Company, without further question, inquiry or qualification, and provide to SRG such information, in writing or otherwise as reasonably requested by SRG, as is necessary for SRG to completely and thoroughly make a retention determination with respect to Company; and
o release, indemnify and hold harmless SRG, third party investigative representatives retained by SRG, as well as the information sources themselves from and against any and all claims, demands, costs, expenses, or liabilities arising from or related to, directly or indirectly, the release of said information by such information sources. This release, indemnity and hold harmless provision shall survive the termination or lapse of this Consent to Release of Information.
It is understood that SRG will use the information obtained hereby solely for the limited purpose of validating the veracity and thoroughness of information separately provided to SRG by Company, in order for SRG to make an informed decision about supply arrangements with SRG. This may involve the use by SRG of third party investigative representatives.
SRG may disclose the information to the extent required by law, by any governmental or other regulatory authority (including, without limitation, any relevant stock exchange or exchange commission), or by a court or other authority of competent jurisdiction.
This Release of Information Consent is agreed to and effective as of the date written below and, except with regards to clause 3 above, shall remain in full force and effect for the latter of: 12 months hereafter or until 12 months after all work, services and product supplied to SRG is complete, at which date this Release of Information Consent shall lapse.
DOCUMENTS TO BE RETURNED BY COMPANY ALONG WITH THE COMPLETED QUESTIONNAIRE
Please provide the following documentation to support the responses you have provided in this questionnaire:
Release of Information Consent Form
Audited Financial Statements (last 3 years)
Void Cheque or Bank issued document, signed by Bank
Bank Details & References
Company Incorporation Certificates
Current (valid) trade registration certificates
Directors Information from Corporate Registry (or equivalent) or Lawyers Letter
Shareholders Information from Corporate Registry (or equivalent) or Lawyers Letter
Proof of Identity for Key Shareholders/Directors where your contract with SRG exceeded $2M CAD in the past calendar year
You are required to supply ONE primary photo identification document from the list below
If this cannot be obtained, you must supply at least ONE primary non-photo identification document and ONE secondary identification document stating the current residential address.
Primary Photo ID
Primary Non-Photo ID
Driver’s License (current)
Driver’s License Permit (current)
Passport (expiry date no less than 2 years from date of submission)
National Photo ID Card (current)
Birth Certificate/Marriage Certificate (confirm maiden name to married name)
Tax Notice (less than 12 months old)
Utility Bill – Electricity, Telephone (landline), etc. (not more than 3 months old)
Group Structure (org chart – list all companies owned or controlled by company)
If Publically Traded; list of each shareholder holding 5% or more individually
WCB Employer Premium Rate Statements (3 years) – for each jurisdiction
WCB Letter in Good Standing (clearance letter) – for each jurisdiction
Annually signed Health, Safety, Environmental (HSE) Policy conforming to legislation
HSE Manual including: (i) Alcohol & Drug policy; (ii) procedure to verify worker competence; (ii) investigation process.
Description of HSSE Citations (if applicable) & description of any Lost Time Injury or Fatality Identified
Recordable incident list, with corrective actions listed for past 3 years
Copy of current company Safety Organizational Chart
Copy of current company Quality Organization Structure
Quality Assurance Program Manual(s)
Project Quality Management Plan (PQMP) sample
Inspection Test Plan (ITP) sample
ISO Certificates, Governing Jurisdiction Certificates
Transportation Suppliers to provide their Carrier Profiles
Validation of Indigenous Ownership (if applicable)
Copy of your company Anti-Bribery as well as Code of Ethics Policies (if applicable)
Copy of Social Fingerprint Audit (SA8000 Standard) (if applicable)
Annual Rate Table