External Contractor Registration

Registrant Information

Full Legal Business Name

First Name

Last Name

Work Phone

Cell Phone

Alternate Contact

First Name

Last Name

Work Phone

Cell Phone

Address

Unit no.

Apartment/unit number or PO. box if applicable

City/Town

Province

Postal Code

GST Number

The following documents MUST be submitted as part of the registration:

Business License

One file only.
10 MB limit.
Allowed types: jpg, png, heic, txt, rtf, odf, pdf, doc, docx.

$5M CGL Insurance

One file only.
10 MB limit.
Allowed types: gif, jpg, heic, png, txt, rtf, pdf, doc, docx.

Registrant must provide either a WorkSafeBC Clearance Letter OR a POP Coverage Letter as part of its application.

WorkSafeBC

POP Coverage

WorkSafe BC Clearance

One file only.
10 MB limit.
Allowed types: gif, jpg, heic, png, txt, rtf, pdf, doc, docx.

POP Coverage

One file only.
10 MB limit.
Allowed types: gif, jpg, heic, png, txt, rtf, pdf, doc, docx.

Acknowledgement of Addenda

The Applicant is deemed to have read and taken into account all addenda issued by the City prior to the Closing Date and Time. The Applicant is requested to confirm that it has received all addenda by listing the addenda numbers, or if no addenda were issued by writing the word “None”, on the following line. Applicants who fail to complete this section will be deemed to have received all posted addenda.

Conflict of Interest Declaration

The Applicant must declare all Conflicts of Interest, as defined. “Conflict of Interest” means any exposure to an actual, perceived or potential conflict of interest by a natural person involved in making our submission in response to this solicitation (whether as the Applicant, our potential subcontractor, or a person in an employment relationship with, having a management or ownership interest in, or benefiting from any other form of financial stake in any such entity), including by way of example:

the person being simultaneously or having been recently engaged in an employment relationship with the City;
the person having been engaged by the City in the preparation of this solicitation, including providing advice that may have been used in the preparation or adoption of any technical specification for this solicitation;
the person being engaged in any business or transaction or having a financial or personal interest that is incompatible with the proper discharge of his or her duties under any Contract that may flow from this solicitation;
the person having a competing interest that threatens the proper and objective performance of his or her duties under any Contract that may flow from this solicitation;
the person having given gifts to employees or managers of the City, except for gifts constituting a benefits to the City or of nominal value; or
the person being in a blood or marriage relationship or close business association with any person listed above.

Please select the appropriate statement:

The Applicant confirms it has no Conflict of Interest to declare; OR

The Applicant confirms it has a Conflict of Interest to declare.

Please describe the "Conflict of Interest" here:

Privacy Notice

Any personal information collected on this form by the City of Prince George is for the purpose of registering equipment for the Equipment for Hire Program and collected under the authority of section 26(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection of information, please contact the Manager of Transportation and Technical Services at 3990 18th Avenue, Prince George, BC, by telephone 250-561-7600 or 311, or email dave.bradshaw@princegeorge.ca.

I agree to the above privacy statement

Yes