Ministry of Contractor Registration (CRF) Transportation...Contact Information Surname Given Name...

023-CRF-01E (02/2007) Version française disponible 1 of 17 © Queen's Printer for Ontario, 2007

Ministry of Transportation

Contractor Registration (CRF)

Company Information Corporate Name

Corporate Number

Jurisdiction

Address

City/Town/Village Province/State Country

Postal/Zip code

Telephone

( )

Fax

( ) E-mail

Contact Information Surname Given Name Position/Title

Address


Postal/Zip code

Telephone Ext. Fax E-mail

( ) ( )

Business Information In business since (yyyy/mm) International Experience

Yes No What size projects and backlog do you feel your organization can undertake at any point in time?

Single Job ($): Total Work Program ($):

Does your company have an approved Quality Management Declaration?

Yes No Number of Employees:

Full Time: Seasonal:

Application Type

Annual Renewal Interim Application

Non-Financial Review First Time Application Fiscal Year End Date (yyyy/mm/dd) Interim Statement Date (yyyy/mm/dd)

Type of Financial Statement(s) Submitted

Audited Review Engagement

023-CRF-01E (02/2007) 2 of 17 © Queen's Printer for Ontario, 2007

Banking Information Bank Name

Account Manager Surname Given Name


( ) ( )

Address


Postal/Zip code

Bonding Information Company Name

Account Manager Surname Given Name


( ) ( )

Address


Postal/Zip code

Bonding Limits Single Job ($) Expiry Date (yyyy/mm/dd)

Aggregate ($) Expiry Date (yyyy/mm/dd)

Class of Contractor

Heavy Construction Water & Sewer

General Building Highway & Street

Bridge & Tunnel

Other, please specify ______________________________________________________________________ What portion (%) of your work is for?What is your operation?

Union Non-Union Government Agencies: Private Owners:


Type of Work What type of work do you normally undertake?

GR – General Road S – Structure

SC – Structure Coating GM – General Maintenance

E – Electrical

Miscellaneous, please specify ________________________________________________________________

In what type of areas do you normally work?

Urban Rural GTA Suburban What type of work will you be bidding on?

MTO Municipal

Litigation Is your organization currently involved in any litigation?

Yes No If yes, please explain fully:

Liens Do you have any construction liens currently outstanding?

Yes No If yes, please explain fully:


Large Project Experience

List the three largest road construction projects completed by your company in the last three years.

New applicants or companies requesting a review of their experience must list their experience and send a “Contract Work Appraisal“ form to all those companies listed below. Companies receiving the Contract Work Appraisal form should submit the completed form directly to the Ministry of Transportation.

Project 1 of 3 Project Name

Company Name Tender Price ($)

Contact Information Surname Given Name Telephone

( ) Address


Postal/Zip code




( ) Address


Postal/Zip code




( ) Address


Postal/Zip code


Current Project Experience

List the three largest road construction projects currently in progress (with % completed).

Project 1 of 3 Project Name % Completed

Company Name Contract Price ($)


( ) Address

City/Town/Village Province/State Country Postal/Zip code




( ) Address





( ) Address



Consultant Experience

If you have worked with a consulting firm in the past 3 years, please provide references.

Reference 1 of 3 Project Name

Company Name


( ) Address



Company Name


( ) Address



Company Name


( ) Address



Owner(s) Key Personnel

New applicants, or if a change occurs in the Company, must attach a resume for each individual listed.

Name (Surname, Given Name) Position/Title Expertise

Associated Companies Corporate Name &

Address Corporate Number

Jurisdiction Relationship 1. Parent 2. Subsidiary 3. Division

Branch 4. Common

Ownership (at least 51%)

If relationship is Parent/

Subsidiary, is there a

Memorandum of Agreement

on file? (Yes/No)

Business Type

Ownership %

Assigned ID


Balance Sheet

As at (yyyy/mm/dd)

With Comparative Figures for

Current Assets $ $ 1. Cash on hand in banks

2. Amount receivable on contracts other than holdbacks

3. Holdbacks on contracts

4. Contract work in progress inventory

5. Other accounts receivable

6. Marketable securities (Lower of cost or market)

7. Inventories (Lower of cost or market)

8. Prepaid expenses

9. Other current assets

Total Current Assets:

Fixed Assets

10. Land (Cost)

11. Buildings (Cost)

12. Furniture and fixtures (Cost)

13. Autos and trucks (Cost)

Sub-Total of 10, 11, 12, 13:

14. Less accumulated depreciation on above

Net Book Value of Above Fixed Assets:

15. Equipment (Cost)

16. Less accumulated depreciation on above

Net Book Value of Equipment:

17. Receivables from officers, directors, partners, employees and shareholders

18. Other Assets

Total Assets:


Liabilities and Shareholders Equity $ $ 19. Due to banks

20. Trade accounts payable

21. Taxes payable

22. Accrued salaries and wages

23. Due to sub-contractors including holdbacks

24. Dividends payable

25. Other current liabilities

26. Portion of long term indebtedness (items 27, 28, 29) due within 12 months

Total Current Liabilities:

27. Liens, mortgages and secured liabilities not due within 12 months

28. Unsecured liabilities to employees, directors and shareholders not due within 12 months

29. Other unsecured liabilities not due within 12 months

Total Deferred Liabilities:

30. Reserves

31. Capital stock

32. Retained earnings

33. Other surplus

Total Capital Surplus:

Total (Current Liabilities + Deferred Liabilities + Capital Surplus):

34. Contingent liabilities


Details of Contract Receivables and Work in Progress (Items 2, 3 and 4 on the Financial Statements) • Show full details for each contract with the Ministry of Transportation • Show full details of each contract with other owners where the award value is over $100,000. Group all others on one line.

Contract Number

Awarded by (Owner)

Award Date (yyyy/mm/dd)

End Date (yyyy/mm/dd)

Award Value

Progress Billings

Amount Receivable Other Than Holdbacks

(Item 2)

Holdbacks (Item 3)

Work in Progress Inventory (Unbilled)

(Item 4)

Totals:

Details of Other Accounts Receivables (Item 5)

Show details concerning the Ten Largest Accounts Receivable and combine the remainder.

Receivable From Address Description Date Billed (yyyy/mm/dd)

Amount $

Total Other Accounts Receivable:

Less Doubtful Accounts:

Total Value (Item 5): $


Details of Other Current Assets (Item 9) Description of Other Current Assets Amount $

Total (Item 9):

Details of Land (Item 10) Description of Land Construction/Business

(A) Investment/Other

(B) Total Value

(C)

Total (Item 10) (A + B = C):

Note: Only land identified as Construction/Business (A) will be used with calculating your adjusted rating. Total Value (C) must agree with Item 10 Land (Cost) on the Financial Statement. Gravel Pits at cost less depletion should be included as Item 10 Land.

Equipment Information Do you have the necessary equipment to perform anticipated job/total work program?

Yes No

If No, how much will you be spending on equipment in the next year?

Will you require financing?

Yes No

Report the value of any liens or Encumbrances not included in Financial Statements


Equipment Summary

Equipment Table Summary ($):

Note:

• Total Purchase Price must agree with Item 15 on the Financial Statements.

• If purchase price does not equal Item 15, please explain in detail otherwise the Net Book Value. Item 16a will be used to calculate the Adjusted Rating.

• Licensed equipment is not to be categorized in the details of the equipment. Please ensure licensed equipment is placed under Item 13. Autos and Trucks.

• Please refer to the Qualification Procedures for Contractors for additional information.

Instructions for entering Equipment in the provided Equipment Table:

Equipment type: Enter an Equipment Type from the Equipment List provided. Year of Purchase: Enter the Year of Purchase for all equipment items of given equipment type purchase in the same

year. Number of Items: Enter the number of equipment items for the given equipment type purchase in the Year of Purchase. Total Cost of Line Item(s): Enter the Total Cost of all equipment items for the given equipment type purchase in the Year of

Purchase.

Equipment List

Air Tools Air Vacuum Cleaning Supplies Batching Equipment – Concrete Paving Batching Equipment – Concrete Structures Bituminous Distributor Bituminous Mixing Plant Bituminous Spreader and Finisher Compressor Crane Crane Attachments Crushing Plant Euclids – Dumpsters etc. (Non-Licensed Equipment) Finisher – Concrete Paving Forms – Concrete Paving Grader Loader – Front End Mixer – Concrete for Culverts/Structures Other Major Items (Specified) Other Major Items (Unspecified) Paint Spray Systems Pumps Roller – Sheepsfoot Roller – Steep and/or Pneumatic Sand Blasters Scale Platform Scraper Spreader Aggregate Sub-Grader Tractor Vibrator – Concrete Work Support Systems


Details of Equipment

Note: Contractors must maintain an itemized list of equipment used in the equipment table for audit purposes.

Equipment Type (from the list on page 12) Please combine equipment of same type by year purchased

Year of Purchase

Number of Items

Total Cost of Line Item(s)

Total:


Details of Other Assets (Item 18) Description of Other Assets Amount $

Total (Item 18):

Lien Notes, Mortgages and Other Secured Liabilities (Item 27) Payable to Portion Due Within 12

Months (Item 26)

Lien Notes, Mortgages and Other Secured

Liabilities

Total (Item 27):

Unsecured Liabilities to Employees, Directors and Shareholders (Item 28) Payable to Details Portion Due

Within 12 Months (Item 26)

Unsecured Liabilities to Employees,

Directors and Shareholders

Deferred (Yes/No)

Portion Not Deferred

($)

Portion Deferred

($)

Totals:


Other Unsecured Liabilities (Item 29) Payable to Details Portion Due Within 12

Months Other Unsecured

Liabilities

Totals:

Reserves (Item 30) - Please provide full description and purpose of all Reserves.

Description Purpose Amount $

Total (Item 30):


Gross Reserves

Total must agree with the figures shown on the Statement of Income. Show five largest MTO, five largest Municipal & five largest other contracts. Lump all others together by MTO, Municipal and Other Categories.

Contract Number Awarded by (Owner)

Award Date (yyyy/mm/dd)

Award Value ($)

Amount Received ($)

Complete %

Total Gross Revenue:

Please report the net profits after taxes as it appears on the Statement of Income:

Net Profit After Tax ($):


Contractor’s Statement

We hereby certify that we are fully informed as to the affairs of

and the information contained in this form is complete and accurate.

I understand that this information will be used to register this company with the Ministry of Transportation, Contractor Qualification. I also understand that registration in this system does not guarantee the availability or award of Ministry contracts and hereby waive all claims resulting from errors or omissions.

Print Name of Contractor Position Surname Given Name

Signature of Contractor Date (yyyy/mm/dd) Witness

Print Name of Contractor Position Surname Given Name

Signature of Contractor Date (yyyy/mm/dd) Witness

Note: Copy of the Auditor’s report, Balance Sheet (including Notes) and Income Statement as presented to the Shareholders or Owners must be enclosed herewith, in accordance with the Qualification Procedures.

To be submitted to: Ministry of Transportation Contract Management Office Head, Qualification Control 301 St. Paul Street St. Catharines, ON L2R 7R4

Date post:	15-Aug-2021
Category:	Documents
Upload:	others
View:	4 times
Download:	0 times

Ministry of Contractor Registration (CRF) Transportation...Contact Information Surname Given Name...

Documents