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Canadian Subcontractor Qualification

Canadian Subcontractor Qualification

  • Please provide the following information relative to your firm's safety performance and program:
  • Certificate of Liability Insurance AND Experience Modification Rate (EMR)

    Please obtain from your insurance agent a Certificate of Liability Insurance showing the general liability and auto coverage. The certificate must list the above selected company's name as a certificate holder as well as an additional insured. Please attach the certificate to this form. We also require a WCB letter of good standing and confirmation of workers compensation coverage.
  • Insurance Requirements:
    General Liability: $2,000,000
    Automobile Liability: $1,000,000
    Umbrella/Excess: $5,000,000 each occurrence
    Workers Compensation: $1,000,000

  • Please provide your workers compensation rate information for the last three rating periods:
  • We require backup for the above information. Please furnish a letter from Workers’ Compensation Board (on their letterhead) verifying the Employer Premium Rate data listed above.
  • Recordable Incidents
  • Furnish your firm’s safety statistics from the past three (3) years.
  • The answers you provide in this section may determine whether you will be permitted to bid work. You are responsible and accountable for providing accurate information. Using your past three years Workers Compensation documents, provide the following injury and illness information:
  • Enter details for Year 1
  • Enter details for Year 2
  • Enter details for Year 3

    Attach the following documents: 2MB MAXIMUM TOTAL FILE SIZE ACCEPTED

  • Safety Program
  • Do you hold safety meetings for: Field Supervisors?
  • Do you hold safety meetings for: Employees?
  • New hires? Orientation
  • Subcontractors?
  • Do you conduct job safety inspections?
  • Irex Risk Management will email notification to you upon approval. You must receive approval prior to work.

    Irex Corporation
    Risk Management Dept
    PO Box 1268
    Lancaster, PA 17608 USA
    Donna Ridinger: