Contractor Information Request Form

Main Company Contact

Main Company Contact*

Main Company Contact Phone*

Main Company Contact Email*

Emergency Contact

Emergency Contact Phone*

Main Company Contact Phone*

WCB Coverage

WCB Account #*

WCB Premium Rate Statement*

Please attach a copy of your current year’s WCB Premium Rate Statement

Accepted file types: pdf, png, jpg, Max. file size: 16 MB.

COR/SECOR

Yes

COR/SECOR #*

Expiry Date*

COR/SECOR certificate*

Please attach a copy of your COR/SECOR certificate, if applicable.

Accepted file types: pdf, png, jpg, Max. file size: 16 MB.

COR/SECOR certificate*

* If you do not have COR/SECOR certification, please attach the Table of Contents from your current Health & Safety Manual.

Accepted file types: pdf, png, jpg, Max. file size: 16 MB.

Insurance Coverage

Name of Insurance Provider*

Insurance Provider Phone*

Policy Expiry Date*

Certificate of Insurance*

Please attach a copy of your Certificate of Insurance

Accepted file types: pdf, png, jpg, Max. file size: 16 MB.

Employee Training/Certification

Required Certifications*

Please check the training/certification that your employees are required to have and/or provide a copy of your training matrix.

Other (please specify)*

Health & Safety Committee

Health & Safety Committee Chairperson/Health & Safety Representative*

First Last

Health & Safety Committee Chairperson/Health & Safety Representative Phone Number

Subcontractor Management

Contractor Services*

While performing work on any Co-op project, will you be using the services of another contractor/subcontractor?

Yes

If yes, your signature on this document acknowledges that you are aware that all subcontractors must complete and submit this form and all required supporting documentation to our office for approval prior to performing work on any Co-op project.

All contractors and their approved subcontractors will immediately notify our office of any changes to the information provided in this document. The Co-op reserves the right to request documentation to support any of the information provided. In addition, any approved contractor or subcontractor will comply with the additional requirements as set out in the contractual documents between the contracting party and the Co-op.

While performing work for the Co-op all contractors and their approved subcontractors agree to notify our office immediately in the event of a critical incident or injury.

Finalize

Name*

First Last

Title*

Today's Date*

Contractor Information Request Form

Company Information

Main Company Contact

Emergency Contact

WCB Coverage

COR/SECOR

Insurance Coverage

Employee Training/Certification

Health & Safety Committee

Subcontractor Management

Finalize