List of names for integrity verification form

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Requirements

Section 17 of the Ineligibility and Suspension Policy requires suppliers, regardless of their status under the policy, to submit a list of names with their bid or offer. The list differs depending on the bidder or offeror’s organizational structure:

Suppliers including those bidding as joint ventures, whether incorporated or not, must provide a complete list of the names of all current directors
Privately owned corporations must provide a list of the owners’ names
Suppliers bidding as sole proprietors, including sole proprietors bidding as joint ventures, whether incorporated or not, must provide a complete list of the names of all owners
Suppliers that are a partnership do not need to provide a list of names

Suppliers may use this form to provide the list of names with their bid or offer submission. Failure to submit this information with a bid or offer, where required, will render a bid or offer non-responsive, or the supplier otherwise disqualified for award of a contract or real property agreement. Please refer to Information Bulletin: information to submit a bid or offer for additional details.

Supplier information

Supplier’s legal name (required)

Organizational structure (required)

corporate entity

privately owned corporation

sole proprietor

Supplier’s address (required)

Supplier’s city (required)

Supplier’s province/territory (required)

Supplier’s postal code (Canada) (A1A 1A1) (required)

Supplier’s procurement business number (optional)

Solicitation or transaction number (required)

Date of bid, offer submission or closing date of Invitation to Offer (yyyy-mm-dd) (required)

List of names

Name 1 (required)

Title 1 (required)

Name 2

Title 2

Name 3

Title 3

Name 4

Title 4

Name 5

Title 5

Name 6

Title 6

Name 7

Title 7

Declaration

I, (name) (required)

(position) (required)

of (supplier’s name) (required) declare that the information provided in this form is, to the best of my knowledge and belief, true, accurate and complete. I am aware that failing to provide the list of names will render a bid or offer non-responsive, or I will be otherwise disqualified for award of a contract or real property agreement. I am aware that during the bid or offer evaluation stage, I must, within 10 working days, inform the contracting authority in writing of any changes affecting the list of names submitted. I am also aware that after contract award I must inform the Registrar of Ineligibility and Suspension within 10 working days of any changes to the list of names submitted.

Signature

Please include with your bid or offer.

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Date modified:: 2017-05-25

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