AMC Prequalification - Short Form / Pré qualification d'AMC - Forme Courte

Minor Works - Prequalification /Travaux mineurs - préqualification
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Type of Entity (Select One) / Type d'entité (Sélectionner) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Registered Address / Adresse Enregistrée {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Copy of latest accounts - preferably audited / Copie des derniers comptes - de préférence audités

Authorized person (name, position and email) / Personne autorisée, (nom, poste et adresse éléctronique)

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Upon submission of application and confirmation email will be sent to this email address. / Lors de la soumission de la candidature et de la confirmation, un courrier électronique sera envoyé à cette adresse électronique.

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Categories of Work / Catégories de travail

Applicants should identify the Categories for which they are applying. / Les candidats devraient identifier les catégories pour lesquelles ils appliquent.

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Insurances / Assurance

Please provide details of the following insurances: (copies of insurance certificates should be attached)

Current or Planned Insurances / Assurances en cours ou prévues

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Prior Experience and Capability / Expérience et Capacité

Please provide details of experience relevant to the Category applied for by describing relevant projects in the last 3 years. Complete below for the minimum information required, additional information should be loaded in table form./ Veuillez fournir des détails sur l'expérience correspondant à la catégorie demandée en décrivant les projets pertinents réalisés au cours des 3 dernières années. Complétez ci-dessous les informations minimales requises, les informations supplémentaires doivent être chargées sous forme de tableau.

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Business Management Systems / Systèmes de gestion d'entreprise

Does the Company have any Business Management Systems? / La société dispose-t-elle de systèmes de gestion d'entreprise?

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Work Health and Safety / Santé et Sécurité au travail

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AMC Prequalification - Short Form / Pré qualification d'AMC - Forme Courte

Trading Name / Nom Commercial {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Type of Entity (Select One) / Type d'entité (Sélectionner) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Registered Address / Adresse Enregistrée {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Telephone Number / Numéro de Téléphone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Email Address / Adresse éléctronique {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Website / Site Web {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Upload copy of audited accounts./ Copie du téléchargement des comptes vérifiés. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
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{binding Description}
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Authorized person (name, position and email) / Personne autorisée, (nom, poste et adresse éléctronique)

Full Name / Nom complet {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Position / Poste {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Email / Adresse éléctronique {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Categories of Work / Catégories de travail

Civil /Earthworks/Drainage Contractor / Entrepreneur civil / travaux de terrassement / drainage {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Electrical Hardware and Engineering Supplies /Matériel électrique et fournitures d'ingénierie {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Building Material Supplies / Fournitures de matériaux de construction {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Haulage/Logistics /Transport Operator / Logistique / Opérateur de Transporteur {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Customs Clearance /Procédures de Dédouanement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Village Construction / Construction de Village {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Village Management / Gestion de village {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Fleet/Equipment Hire / Flotte / location d'équipement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Marine and Barging Services / Services maritimes et barges {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Building – Construction and Maintenance / Entrepreneur en bâtiment (résidentiel) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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HVAC Engineering / Repair / Génie CVC / Réparation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Bridge Maintenance / Maintenance du pont {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Traffic Management, Intersections / Gestion du trafic, intersections {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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I.T Services – Hardware and Support / Fourniture de matériel et Services Informatiques {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Other / Autre {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Insurances / Assurance

Current or Planned Insurances / Assurances en cours ou prévues

Details of Insurances / Détails des assurances {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Copies of relevant Insurance Certificates / Copies des certificats d'assurance pertinents {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
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Prior Experience and Capability / Expérience et Capacité

Project details - General Information / Détails du projet - Information générale {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Client contact details (Name / Tel. No. Email) / Coordonnées de l'arbitre (Nom / N ° de téléphone Email) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Location of project / Emplacement du projet {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Other Information / Autres informations {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Additional Project Description to be uploaded / Description de projet supplémentaire à télécharger {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
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{binding Description}
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Business Management Systems / Systèmes de gestion d'entreprise

QA (Quality Assurance); certification to ISO standard: / AQ (assurance qualité); certification à la norme ISO: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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OHS&R (Occupational Health Safety and Rehabilitation); certification to ISO standard: / SST & R (Sécurité et réadaptation en santé au travail); certification à la norme ISO: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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EMS (Environmental Management System); certification to ISO standard: / SME (système de gestion de l'environnement); certification à la norme ISO: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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HR/IR certification to ISO standard:/Certification RH / Relations Industrielles à la norme ISO: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Other if Relevant / Autres le cas échéant {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Work Health and Safety / Santé et Sécurité au travail

Please provide details of your work health and safety record over the last 24 months showing all incidents. / Veuillez fournir des détails sur votre dossier de santé et de sécurité au travail au cours des 24 derniers mois, en indiquant tous les incidents. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Other Relevant Information / Autres informations pertinentes {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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AMC Prequalification - Short Form / Pré qualification d'AMC - Forme Courte

Minor Works - Prequalification /Travaux mineurs - préqualification
Trading Name / Nom Commercial {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Type of Entity (Select One) / Type d'entité (Sélectionner) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Registered Address / Adresse Enregistrée {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Telephone Number / Numéro de Téléphone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email Address / Adresse éléctronique {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Website / Site Web {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Upload copy of audited accounts./ Copie du téléchargement des comptes vérifiés. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }

Authorized person (name, position and email) / Personne autorisée, (nom, poste et adresse éléctronique)

Full Name / Nom complet {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Position / Poste {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email / Adresse éléctronique {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
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Categories of Work / Catégories de travail

Civil /Earthworks/Drainage Contractor / Entrepreneur civil / travaux de terrassement / drainage {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Electrical Hardware and Engineering Supplies /Matériel électrique et fournitures d'ingénierie {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Building Material Supplies / Fournitures de matériaux de construction {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Haulage/Logistics /Transport Operator / Logistique / Opérateur de Transporteur {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Customs Clearance /Procédures de Dédouanement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Village Construction / Construction de Village {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Village Management / Gestion de village {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Fleet/Equipment Hire / Flotte / location d'équipement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Marine and Barging Services / Services maritimes et barges {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Building – Construction and Maintenance / Entrepreneur en bâtiment (résidentiel) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
HVAC Engineering / Repair / Génie CVC / Réparation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Bridge Maintenance / Maintenance du pont {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Traffic Management, Intersections / Gestion du trafic, intersections {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
I.T Services – Hardware and Support / Fourniture de matériel et Services Informatiques {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Other / Autre {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Insurances / Assurance

Current or Planned Insurances / Assurances en cours ou prévues

Details of Insurances / Détails des assurances {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Copies of relevant Insurance Certificates / Copies des certificats d'assurance pertinents {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
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Prior Experience and Capability / Expérience et Capacité

Project details - General Information / Détails du projet - Information générale {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Client contact details (Name / Tel. No. Email) / Coordonnées de l'arbitre (Nom / N ° de téléphone Email) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Location of project / Emplacement du projet {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Other Information / Autres informations {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Additional Project Description to be uploaded / Description de projet supplémentaire à télécharger {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
{ binding firstError.message }

Business Management Systems / Systèmes de gestion d'entreprise

QA (Quality Assurance); certification to ISO standard: / AQ (assurance qualité); certification à la norme ISO: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
OHS&R (Occupational Health Safety and Rehabilitation); certification to ISO standard: / SST & R (Sécurité et réadaptation en santé au travail); certification à la norme ISO: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
EMS (Environmental Management System); certification to ISO standard: / SME (système de gestion de l'environnement); certification à la norme ISO: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
HR/IR certification to ISO standard:/Certification RH / Relations Industrielles à la norme ISO: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Other if Relevant / Autres le cas échéant {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
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Work Health and Safety / Santé et Sécurité au travail

Please provide details of your work health and safety record over the last 24 months showing all incidents. / Veuillez fournir des détails sur votre dossier de santé et de sécurité au travail au cours des 24 derniers mois, en indiquant tous les incidents. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
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Other Relevant Information / Autres informations pertinentes {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Cognito Forms{{ Cognito.resources["powered-by-cognito"] }}