Supplier Registration Form

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Suppliers

Supplier Registration Form

Company Information

Date:

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Company name:

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Contact name:

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Company position:

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Province:

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City:

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Street address:

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Postal code:

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Phone number:

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Email:

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Website:

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Extended Company Information

If applicable, please provide a piece of marketing material:

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Years in service:*

0-23-56-1011-2020+

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Count of employees:*

0-1010-2525-5050-100100-200200+

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Do you have an indigenous inclusion policy?*

YesNo

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If yes, please provide documentation of your inclusion policy:

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If applicable, please provide documentation of your indigenous content policy:

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If not, please provide summarization of your content policies:

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List any indigenous associations your company is connected with:

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Is the ownership of your company 51% or greater of any of the following?

indigenous group or communityVisible minorityFemalePerson with disability

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If you selected indigenous group or community, then name the group or community:

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Please select the option that best defines your company:*

Sole-ProprietorshipPartnership Limited PartnershipLimited Liability CompanyCorporation - PrivateCorporation - PublicSubsidiaryJoint ventureOther

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If subsidiary, name parent company:

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If other, please specify:

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Company Service Information

Briefly explain the services of your company:*

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What category does your service(s) fall under:*

Cathodic ProtectionCivilCoatingCold CuttingCommunicationConcreteConstructionContainmentDaylightingElectricalEngineeringEnvironmentalFabricationFencingField ServicesInsulationJanitorialMachiningMetal BuildingsMRO SupplierPilingPipelinePVF SupplierPWHTQualityRentalsSafetyScaffoldSecuritySite ServicesSteel SupplierToolsTransportation

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Expanded service sub-categories:*

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What province(s) do you operate in:*

BCABSKMBONQCNLNBNSP.E.IYTNTNU

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List your operating regions within your selected provinces:*

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If possible, please provide documentation or a list of your equipment:

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If not, give us a written list of your equipment:

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Project History

Project name:

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Location:

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Who was the primary contractor?

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Approximate contract value:

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Time to complete project:

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Your role in the project:

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Outcome of the project:

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Safety Information

What was your TRIF rating last year?

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What is your current TRIF rating?

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What was your LTIF rating last year?

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What is your current LTIF rating?

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When does your COI expire?

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What provinces do you have a COR?

British Colombia (BC)Alberta (AB)Saskatchewan (SK)Manitoba (MB)Ontario (ON)Quebec (QC)Newfoundland and Labrador (NL)New Brunswick (NB)Nova Scotia (NS)Prince Edward Island (P.E.I)Yukon Territory (YT)Northwest Territories (NT)Nunavut (NU)

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When does your Alberta COR registration expire?

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WCB Registered Region(s):

BCABSKMBONQCNLNBNSP.E.IYTNTNU

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Please enter the WCB ratings for your registered region(s):

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Are you ISO certified?

YesNo

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If yes, to which type of QA program:

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Additional and Legal Information

Employee training programs:

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Is your company associated with any of the following networking groups:

AMTAAvetta (formerly PICS)CanQualComplyWorksEnformISNetworldPSACOther

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If other, please specify:

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Please provide a list of your company's certifications:*

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Do you have Liability Insurance:*

YesNo

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Do you have a Business License:*

YesNo

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Is your business Incorporated:*

YesNo

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Confirm you are human:

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Make sure to check your answers before submitting

Helping Customers Bring Resources to Our World

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ClearStream Energy Services, Suite 415, 311 - 6 Ave SW, Calgary, Alberta, T2P 3H2

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