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Supplier Registration

Guidelines

Please contact Veridian’s Purchasing Department if you need assistance with the registration process.
This online form must be completed in its entirety unless otherwise noted in subsequent instructions.
Documents outlined in the Supporting Documentation Checklist below must be sent to Veridian Connections at the following address:
Veridian Connections Inc.
ATTN: Purchasing Department
55 Taunton Rd. E.
Ajax, ON
L1T 3V3
Insurance: Veridian will only accept insurance certificates as proof of insurance. Page one of an Insurance Declaration or a premium statement will not be accepted.
A WSIB Clearance Certificate issued by the WSIB must be submitted

Supporting Documentation Checklist

Copies of liability insurance certificates for all company liability insurance policies as outlined in "Guidelines" above. The insurance policy shall provide for a minimum of five million dollars ($5,000,000) coverage.
Copy of current WSIB Clearance Certificate
Copy of Health & Safety Policy or Statement

Company Registration

Business Contact Information

Your organization's legal name is: *

Select your organization's legal structure: *

Address

Street:
City:
Province/State:
Postal Code/Zip Code:

* All address fields required.

Phone number: *

Fax number:

Toll free number:

Email address: *

Business Number or HST Number: *

Website address:

General Information

Your organization is a: *
If Other:
Year your organization was established: *
Number of full-time employees: *
Union affiliation:
Number of relevant jobs completed in the last five years: *
Value of relevant jobs completed in the last five years: *
WSIB Firm Number:
WSIB Account Number:

Financial Information

Financial Institution:
Contact person:
Title:
Phone number:
Fax number:
Email address:

Company Principals

Name:
Title:
Phone number:
Fax number:
Email address:

Name:
Title:
Phone number:
Fax number:
Email address:

Name:
Title:
Phone number:
Fax number:
Email address:

Name:
Title:
Phone number:
Fax number:
Email address:

Contact Information

Enter your primary contact first, followed by any additional contacts.

First name:
Last name:
Position or job title:
Phone number:
Extension:
Fax number:
Email address:

First name:
Last name:
Position or job title:
Phone number:
Extension:
Fax number:
Email address:

First name:
Last name:
Position or job title:
Phone number:
Extension:
Fax number:
Email address:

Legal

Is your company a party to any judgements, claims, or lawsuits pending or outstanding?	Yes No
If yes, please explain:
Is your company involved in any bankruptcy or reorganization proceedings?	Yes No
If yes, please explain:

References

Enter up to two of your company’s largest relevant jobs completed in the recent past.

Job - 1

Reference company name:

Contract Number (if applicable):

Project title:

Project description:

Address

Street:
City:
Province/State:
Postal Code/Zip Code:

Functioned as:

Contact Information

First name:
Last name:
Position or job title:
Phone number:
Extension:
Fax number:
Email address:

Start date:

End date:

Value of project:

Job - 2

Reference company name:

Contract Number (if applicable):

Project title:

Project description:

Address

Street:
City:
Province/State:
Postal Code/Zip Code:

Functioned as:

Contact Information

First name:
Last name:
Position or job title:
Phone number:
Extension:
Fax number:
Email address:

Start date:

End date:

Value of project:

Products and Services

Describe the main products supplied or services performed:

Describe the main products supplied or services performed

Manufacturer	Distributor	Construction	Construction Design
Maintenance	Service Work	Consultant	Other

If Other, specify:

Please list briefly ADDITIONAL products and services your company provides.

Product or Service

Product or Service:
	This product / service is already provided to Veridian

Product or Service:
	This product / service is already provided to Veridian

Product or Service:
	This product / service is already provided to Veridian

Safety and Environmental Obligation

Please complete the following Contractor Safety and Environmental Obligation by checking the boxes if you agree to comply with the statement.

Please check your agreement to each item below to indicate acceptance.

	Contractor will comply with all applicable Acts and Regulations as well as Veridian’s Health & Safety Policies and Procedures.
	Contractor will be responsible for ensuring that all of its employees and subcontractors successfully complete Veridian’s Health & Safety Orientation session.
	Contractor is aware of all job site hazards and has implemented appropriate policies and procedures to ensure the safety of all employees and subcontractors.
	Contractor is responsible for ensuring that all of its employees and subcontractors comply with all applicable Acts and Regulations, as well as Veridian’s Health & Safety Policies and Procedures.
	Contractor is responsible to notify all appropriate Regulatory authorities as required to fulfill its contractual obligation as per the tender documents (e.g. reporting of accidents, work refusals, etc.). Information is to be simultaneously provided to Veridian’s designated representative.
	Contractor provides written documentation of Workplace Hazardous Materials Information System (WHMIS) training for all employees, and maintains training records for all subcontractors. All hazardous materials.
	Material Safety Data Sheets (MSDS) to be used on a Veridian site by the contractor or its subcontractors must be supplied to Veridian with ample time provided for review with Veridian’s Joint Health & Safety Committee or representative, before any work is undertaken on the site.
	Contractor must appoint a competent person as a supervisor as required by the OHSA.
	Contractor will coordinate all work activities (especially high-risk) through Veridian’s designated representative, prior to commencing with activities.
	Contract will conduct clean-up of work area at least daily.
	Contractor will provide, inspect and maintain PPE as required for employees and ensure the same is completed for subcontractors.

Failure to comply with any of the above may lead to termination of work contract.

Acknowledgement

I have received and read a copy of the Veridian Contractor Safety and Environmental Obligation and agree, on behalf of my company to comply with the requirements of this document and all requirements of the Occupational Health and Safety Act and Regulations and any amendments or other safety regulations which pertain to our work, Furthermore, we will take all necessary precautions for the health and safety of our workers, suppliers and subcontractors while at the workplace and ensure that they are provided with and are aware of the preceding requirements.


Contractor or Representative Name *	Date *	Digital Signature (initials) *

Quick Links

Contact Information and Office Location

Supplier Registration

Guidelines

Supporting Documentation Checklist

Company Registration

Business Contact Information

Address

General Information

Financial Information

Company Principals

Contact Information

Legal

References

Job - 1

Address

Contact Information

Job - 2

Address

Contact Information

Products and Services

Product or Service

Safety and Environmental Obligation

Acknowledgement

Quick Links

Standard Documents and Forms