SUBCONTRACTOR REGISTRATION FORM Thank you for you interest in working with the Orphan Well Association. Please fill out the information below for pre-qualification of Subcontractors. General InformationLegal business name*Operating name*Contact name* First Last Contact title*Contact email address* Email Address Confirm Email Address Contact phone #*Corporate head office address* Street Address Address Line 2 City State/ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Is your company registered to work in Alberta?*Please select oneYESNOGST number?*Please select oneYESNOCompany Organizational StructureWhat is the legal structure of your company?*Please select oneIncorporatedSole ProprietorLimited PartnershipCorporate organization (provide details)*Years in business?*Number of employees? (in Office and in Field)*Please list your company's field office locations (if applicable)Does your company hire Subcontractors?*Please select oneYESNODoes your company require Subcontractors to sign a MSA (Master Services Agreement)?*Please select oneYESNODoes your company have a procurement process in place to qualify Subcontractors?*Please select oneYESNOHistory, ReputationPlease provide a short work history including a few companies you have provided service to in the last 3 years and some references on work volume and type of service.*Has your company worked with the OWA?*Please select oneYESNOIf your company has worked with OWA, please describe past experience and geographical location.Does your company have a current MSA with a Prime Contractor that works with OWA?*N/AFrontierVertexCodeco-VanocoELMWestrock Energy ConsultantsWestern Petroleum ManagementOil and Gas Resource ManagementTo make more than one selection, please use the CNTRL key + click to select.If not, is your company willing to sign and MSA with an OWA Prime Contractor?*Please select oneYESNOGoods and ServicesSelect which service or goods your company provides:*NoneService RigsDownhole Tools specifically for downhole abandonmentsTo make more than one selection, please use the CNTRL key + click to select.Describe how your company can best provide goods and/or services?*Service Rigs - ContinuedIs your company's Commercial & General Liability insurance up to date?*Please select oneYESNOHow many active/workable rigs does your company have? Please include field locations.*Is your company a member of CAODC? (Canadian Association of Oilwell Drilling Contractors)*Please select oneYESNOIs your company a member of PSAC? (Petroleum Services Association of Canada)*Please select oneYESNODoes your company have a service rig management system?*Please select oneYESNODoes your company have a safety management system?*Please select oneYESNOHow many wells have you decommissioned and/or abandoned in the past 3 years?*Downhole Tools - ContinuedDescribe your downhole tools offering?*Please Describe your tools inventory (small, medium, large) and the availability to deploy tools for specific project for a certain time, transport, flexibility on field supervision.*Where are your company's manufacturing facilities?*Does your company have a quality control system?*Please select oneYESNOSafetyIs your company subscribed to ComplyWorks or another compliance management system?*Please select oneYESNODoes your company currently have Alberta WCB coverage?*Please select oneYESNOIs your company's WCB in Good Standing?*Please select oneYESNODo you have safety certification: COR, SECOR? (Certificate of Recognition, Small Employer Certificate of Recognition)*Please select oneYESNOWhat was your TRIF (Total Recoverable Injury Frequency) in 2020?*What was your TRIF in 2019?*What was your TRIF in 2018?*Has your organization completed an external health and safety audit in the past three years?*Please select oneYESNODoes your company have a HSE department? If not, describe how safety is handled.*Does your company have a HAZARD ID (Hazard Identification) and Safety Risk Management system?*Please select oneYESNODoes your company have a program/process to communicate information (hazard alerts, incident reviews) and maintain the records?*Is your company ISO Certified?*Please select oneYESNOHow did you hear about the Supplier of Choice Program?*Please select oneOWA WebsiteLinkedInThrough Prime ContractorPeer ReferralSocial MediaGoogle/Search EngineOtherWould you like to be added to our email list?*Please select oneYESNOPrivacy DisclaimerBy submitting any information to the OWA in connection with its pre-qualifying selection process (the "Process") you: (i) grant the OWA consent to collect, use and disclose such information for the purposes of assessing your eligibility to be pre-qualified for the following key supply categories: service rigs and downhole tools; and (ii) acknowledge and agree that any information submitted by you in response to the Process shall not be considered confidential and shall at all times remain the exclusive property of the OWA and may be used by the OWA without accounting therefore to you. You acknowledge that the OWA is requesting information from you in order to assess which contractors or suppliers may be qualified to perform work or services to the OWA from time to time. The OWA has no obligation to you arising from the Process or the submission of any information by you in response to the Process. For greater certainty, the Process is not an offer to contract, and the OWA does not intend, by way of the Process, to make any offer to create a contractual relationship that can be accepted by you. The OWA will have no obligation to enter into a contract with you in respect of the provision of the work that is contemplated within the Process. The OWA shall only have obligations to you, and you shall only have an obligation to the OWA, if you and the OWA mutually agree to execute a written agreement in connection with any work or services following the submission of information. The OWA makes no representations, covenants, warranties or guarantees, express or implied, to you regarding the Process, the accuracy of any information within Process, or the likelihood that the OWA will enter into a contract with you for the provision of any work or services in connection with the Process. The OWA is simply seeking information from you which is subject to the Process in order to assess whether you may be interested and qualified to perform future work or services that may arise from time to time in connection with the Process. Nothing within Process shall be construed as being an offer of any kind to you to perform any work or services in connection with the Process or otherwise and the OWA makes no representation to you that you may be awarded any work or services whatsoever in connection with the Process.