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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
Contact Information Surname Given Name Position/Title
Address
City/Town/Village Province/State Country
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
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Banking Information Bank Name
Account Manager Surname Given Name
Telephone Ext. Fax E-mail
( ) ( )
Address
City/Town/Village Province/State Country
Postal/Zip code
Bonding Information Company Name
Account Manager Surname Given Name
Telephone Ext. Fax E-mail
( ) ( )
Address
City/Town/Village Province/State Country
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:
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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:
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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 ($)
Contact Information Surname Given Name Telephone
( ) Address
City/Town/Village Province/State Country
Postal/Zip code
Project 2 of 3 Project Name
Company Name Tender Price ($)
Contact Information Surname Given Name Telephone
( ) Address
City/Town/Village Province/State Country
Postal/Zip code
Project 3 of 3 Project Name
Company Name Tender Price ($)
Contact Information Surname Given Name Telephone
( ) Address
City/Town/Village Province/State Country
Postal/Zip code
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Current Project Experience
List the three largest road construction projects currently in progress (with % completed).
Project 1 of 3 Project Name % Completed
Company Name Contract Price ($)
Contact Information Surname Given Name Telephone
( ) Address
City/Town/Village Province/State Country Postal/Zip code
Project 2 of 3 Project Name % Completed
Company Name Contract Price ($)
Contact Information Surname Given Name Telephone
( ) Address
City/Town/Village Province/State Country Postal/Zip code
Project 3 of 3 Project Name % Completed
Company Name Contract Price ($)
Contact Information Surname Given Name Telephone
( ) Address
City/Town/Village Province/State Country Postal/Zip code
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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
Contact Information Surname Given Name Telephone
( ) Address
City/Town/Village Province/State Country Postal/Zip code
Reference 2 of 3 Project Name
Company Name
Contact Information Surname Given Name Telephone
( ) Address
City/Town/Village Province/State Country Postal/Zip code
Reference 3 of 3 Project Name
Company Name
Contact Information Surname Given Name Telephone
( ) Address
City/Town/Village Province/State Country Postal/Zip code
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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
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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:
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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
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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): $
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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
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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
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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:
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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:
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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):
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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 ($):
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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