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The focus of this particular slideshow is Section 1 – “General Information” City of Fort Saskatchewan Safety Qualification Form • Thank you for choosing to work with the City of Fort Saskatchewan! • This slide show is intended to help walk you through filling in the form and providing examples of what attachments will be required.

Section 1: General Information What is the legal name of the company? 1. GENERAL INFORMATION Company Name: AB 123456789 Operates as: Street Address: Mailing Address: City: Province: Postal Code: Bus Telephone: ( ) Fax: ( ) Contact Information Name Primary Phone Email Primary Contact HSE Contact

Section 1: General Information What is the physical location of a main office? 1. GENERAL INFORMATION AB 123456789 Street Address: 1122 Boogie Woogie Ave NW Company Name: Operates as: Mailing Address: City: Province: Postal Code: Bus Telephone: ( ) Fax: ( ) Contact Information Name Primary Phone Email Primary Contact HSE Contact

Section 1: General Information What is the City in which that main office resides? 1. GENERAL INFORMATION AB 123456789 Street Address: 1122 Boogie Woogie Ave NW City: Funkytown Company Name: Operates as: Mailing Address: City: Province: Postal Code: Bus Telephone: ( ) Fax: ( ) Contact Information Name Primary Phone Email Primary Contact HSE Contact

Section 1: General Information What is the Province/State where the City is? 1. GENERAL INFORMATION AB 123456789 Street Address: 1122 Boogie Woogie Ave NW City: Funkytown Province: Alberta Company Name: Operates as: Mailing Address: City: Province: Postal Code: Bus Telephone: ( ) Fax: ( ) Contact Information Name Primary Phone Email Primary Contact HSE Contact

Section 1: General Information What is the Postal/Zip code for the physical location? 1. GENERAL INFORMATION AB 123456789 Street Address: 1122 Boogie Woogie Ave NW City: Funkytown Province: Alberta Postal Code: T 0 T 0 T 0 Company Name: Bus Telephone: ( ) Operates as: Mailing Address: City: Province: Postal Code: Fax: ( ) Contact Information Name Primary Phone Email Primary Contact HSE Contact

Section 1: General Information What is the name in which the company is commonly known? 1. GENERAL INFORMATION AB 123456789 Street Address: 1122 Boogie Woogie Ave NW City: Funkytown Province: Alberta Postal Code: T 0 T 0 T 0 Company Name: Bus Telephone: ( ) SNF Dancefloor Repair Operates as: Mailing Address: City: Province: Postal Code: Fax: ( ) Contact Information Name Primary Phone Email Primary Contact HSE Contact

Section 1: General Information Where does the mail go if different from physical location of the main office? 1. GENERAL INFORMATION AB 123456789 Street Address: 1122 Boogie Woogie Ave NW City: Funkytown Province: Alberta Postal Code: T 0 T 0 T 0 Company Name: Bus Telephone: ( ) Operates as: Mailing Address: City: Province: Postal Code: SNF Dancefloor Repair 2001 Odyssey Street Travoltaville OR… Alberta T 0 T 0 T 1 Fax: ( ) Contact Information Name Primary Phone Email Primary Contact HSE Contact

Section 1: General Information Where does the mail go if different from physical location of the main office? 1. GENERAL INFORMATION AB 123456789 Street Address: 1122 Boogie Woogie Ave NW City: Funkytown Province: Alberta Postal Code: T 0 T 0 T 0 Company Name: Bus Telephone: ( ) Operates as: Mailing Address: SNF Dancefloor Repair Same as Street Address City: Province: Postal Code: Fax: ( ) Contact Information Name Primary Phone Email Primary Contact HSE Contact

Section 1: General Information Is there a central switchboard or primary number that can be called? 1. GENERAL INFORMATION AB 123456789 Street Address: 1122 Boogie Woogie Ave NW City: Funkytown Province: Alberta Postal Code: T 0 T 0 T 0 Bus Telephone: ( ) 780 867 -5309 Company Name: Contact Information Operates as: Mailing Address: SNF Dancefloor Repair Same as Street Address City: Province: Postal Code: Fax: ( ) Name Primary Phone Email Primary Contact HSE Contact

Section 1: General Information What is the number for a facsimile machine? If there isn’t one, print “None” 1. GENERAL INFORMATION AB 123456789 Street Address: 1122 Boogie Woogie Ave NW City: Funkytown Province: Alberta Postal Code: T 0 T 0 T 0 Bus Telephone: ( ) 780 867 -5309 Company Name: Contact Information Operates as: Mailing Address: SNF Dancefloor Repair Same as Street Address City: Province: Postal Code: 780 992 -0001 Fax: ( ) Name Primary Phone Email Primary Contact HSE Contact

Section 1: General Information Who is the manager or supervisor who will be responsible for any projects? 1. GENERAL INFORMATION AB 123456789 Street Address: 1122 Boogie Woogie Ave NW City: Funkytown Province: Alberta Postal Code: T 0 T 0 T 0 Bus Telephone: ( ) 780 867 -5309 Company Name: Contact Information Operates as: Mailing Address: City: Province: Postal Code: 780 992 -0001 Fax: ( ) Name Primary Contact HSE Contact John Dance SNF Dancefloor Repair Same as Street Address Primary Phone Email

Section 1: General Information What is the phone number where direct contact can be made to the primary? 1. GENERAL INFORMATION AB 123456789 Street Address: 1122 Boogie Woogie Ave NW City: Funkytown Province: Alberta Postal Code: T 0 T 0 T 0 Bus Telephone: ( ) 780 867 -5309 Company Name: Contact Information Operates as: Mailing Address: City: Province: Postal Code: 780 992 -0001 Fax: ( ) Name Primary Contact HSE Contact John Dance SNF Dancefloor Repair Same as Street Address Primary Phone 780 992 -0002 Email

Section 1: General Information What is the email address that goes direct to the primary? 1. GENERAL INFORMATION AB 123456789 Street Address: 1122 Boogie Woogie Ave NW City: Funkytown Province: Alberta Postal Code: T 0 T 0 T 0 Bus Telephone: ( ) 780 867 -5309 Company Name: Contact Information Operates as: Mailing Address: City: Province: Postal Code: 780 992 -0001 Fax: ( ) Name Primary Contact HSE Contact John Dance SNF Dancefloor Repair Same as Street Address Primary Phone 780 992 -0002 Email dance@snf. ca

Section 1: General Information Who is the person internal to the company that can answer HSE questions? 1. GENERAL INFORMATION AB 123456789 Street Address: 1122 Boogie Woogie Ave NW City: Funkytown Province: Alberta Postal Code: T 0 T 0 T 0 Bus Telephone: ( ) 780 867 -5309 Company Name: Contact Information Primary Contact HSE Contact Operates as: Mailing Address: City: Province: Postal Code: 780 992 -0001 Fax: ( ) Name John Dance Safety Dance SNF Dancefloor Repair Same as Street Address Primary Phone 780 992 -0002 Email dance@snf. ca

Section 1: General Information What is the phone number where direct contact can be made to the HSE representative? 1. GENERAL INFORMATION AB 123456789 Street Address: 1122 Boogie Woogie Ave NW City: Funkytown Province: Alberta Postal Code: T 0 T 0 T 0 Bus Telephone: ( ) 780 867 -5309 Company Name: Contact Information Primary Contact HSE Contact Operates as: Mailing Address: City: Province: Postal Code: 780 992 -0001 Fax: ( ) Name John Dance Safety Dance SNF Dancefloor Repair Same as Street Address Primary Phone 780 992 -0002 780 992 -0003 Email dance@snf. ca

Section 1: General Information What is the email address that goes direct to the HSE representative? 1. GENERAL INFORMATION AB 123456789 Street Address: 1122 Boogie Woogie Ave NW City: Funkytown Province: Alberta Postal Code: T 0 T 0 T 0 Bus Telephone: ( ) 780 867 -5309 Company Name: Contact Information Primary Contact HSE Contact Operates as: Mailing Address: City: Province: Postal Code: 780 992 -0001 Fax: ( ) Name John Dance Safety Dance SNF Dancefloor Repair Same as Street Address Primary Phone 780 992 -0002 780 992 -0003 Email dance@snf. ca safety@snf. ca

If you still have questions, please contact your for City of Fort Thanks Saskatchewan viewing!representative. Vendor Management The Pre-Qualification Package and You! Section 1 – General Info