If you have any questions or problems with this form, please contact firstname.lastname@example.org.
Application Instructions: Please fill in all fields and check-off all boxes. Type “N/A” in fields where the information is not applicable.
NOTE: This is the Maintenance Application Form for QP 1, 2, 3, 4, 6, 7, 8 and 9, as well as QS 1 and QN 1. If you need to submit a Maintenance Application for QP 5, please use the form found here.
QP Certification Being Renewed
QP 1QP 2QP 3QP 4QP 6QP 7QP 8QP 9QS 1QN 1
Your Name (required)
Your Email (required)
A copy of this form will be sent to this email.
Section 1 Company Information
QC Supervisor Name
QC Supervisor Email
EH&S Officer Name
EH&S Officer email
Production Manager Name
Security officer (for access to secure jobsites)
Please List all company owners. (First name & Last name if you are not publicly traded).
Attach list of all Branch / Division Office Addresses and Contact Information (names, phone numbers, and email addresses), if no file is uploaded it is assumed Company only has one main office.
Section 2: Acknowledgements
Check the boxes as necessary to acknowledge/verify each item. Upload the Corresponding Files. Organization Chart is Required.
The contractor acknowledges that it has completed at least one internal audit in the previous 12 months for each QP Certification held. The SSPC auditor may ask for a copy of the internal audit during your annual audit or request that you provide it to the SSPC Certification Manager when completed
By checking this box, you indicate that you have provided a diagram that shows lines of authority and responsibility for major activities of the company. The organization chart must be dated, clearly showing key positions by name and title (e.g., Health & Safety Officer, QCS, Production Manager) and signed by the Company Executive. Note that company employees must fill key positions. If you use a staff leasing company or other provider of labor, please provide documentation showing that key management personnel are employees of your company
By checking this box, you indicate that you have provided names and qualifications of persons who have replaced key management personnel who left the company or were reassigned since the last maintenance application
By checking this box, you indicate that you have provided or will provide by due date the annual QP administrative maintenance fees and audit deposit, as applicable, for the QP certification(s) being renewed. (Note: one $500 late fee per contractor applies to renewals received after Dec 15.)
Have there been any major changes in the company's organization since last year's application submittal? See "program rules" for definitions of major organizational changes.
Section 3: environmental, Health and Safety Compliance Information
By checking this box, the contractor has provided Worker's Compensation Experience Modification Rates (EMR, both Interstate & Intrastate) for State/Province of Domicile and each principle State/Province of Operation (provide on Insurance Company and/or State/Province Worker's Compensation Bureau Letterhead). Canadian contractors can provide most recent ERA from their Provincial WC Board. If no EMR, provide supporting documentation that Worker's Compensation is or has been provided in accordance with applicable regulations. If you are self-insured, please provide supporting documentation.
By checking this box, you indicate that you have provided current OSHA 300 and 300A forms if U.S.- based. If not U.S.-based, you indicate that you have provided a listing of losses suffered during the past calendar year to the present.
Section 4: Company Practices
If answering Yes to any of these questions please upload a detailed explanation and supporting documentation. Otherwise, a file upload is not necessary
1. Has the applicant had fraud, as documented by a facility owner or its representative or alleged to have taken place by a credible source such as a government agency or other credible third party.
2. Has the company had instances of altering reports, documents, or test results on a project, as documented by facility owner or representative or other customer.
3. Has there been any criminal conviction of the owner, officers, directors, or managing agents of the contracting firm for a felony related to surface preparation and coating application operations of the business, whether the conviction arises by a finding of guilty by a job or jury, a plea of guilty, or a plea of nolo contendere.
4. Has there been any instances by the applicant of misrepresentation or omission of information required for certification, as documented by SSPC.
5. Illegal or unethical business practices, such as but not limited to falsification of certified payroll, administrative actions, or systematic violation of labor or tax laws, or false claims issued to your company as a principal owner or manager.
6. Is your company currently disqualified, disbarred, or ineligible to bid for a particular facility owner?
7. Has your company or any affiliated companies been disqualified, disbarred, or ineligible to bid any projects in the previous 18 months?
8. Has your company failed to successfully complete a project or complete it on time in the last 18 months?
If applicable to the applicant
9. Have you informed SSPC of any and all lawsuits, dispute resolutions, mediations, (local, state, or federal), or other legal actions or administrative actions filed against your company or an affiliated company or a company owner or principal manager (see definition Exhibit “A”) for alleged or actual violations of contracts, regulations, or laws pertaining to its operations, and the current status of each?
10. Has the applicant had any regulatory citations issued to your company for alleged violations of statutes or regulations? If so attach documentation.
11. Is your company ISO 9001 2008/2015 Certified (or does it hold other 3rd party Quality Management Certifications)?
12. If your company has been audited by any outside organization for quality practices, safety and environmental compliance practices, for review of financial or payroll records or other administrative functions, please provide copy of audit results.YesNoN/A
Section 5: Special Notices
“Affiliates.” Business concerns, organizations, or individuals are affiliates of each other if, directly or indirectly: (1) either one controls or has the power to controlthe other, or (2) a third party controls or has the power to control both. (Indicia of control include, but are not limited to, interlocking management or ownership,identity of interests among family members, shared facilities and equipment, common use of employees), (3) Is a business entity organized following the revocation,suspension, or proposed for same of a contractor which has the same or similar management, ownership, or principal employees as the contractor that was subject torevocation or debarred, suspended, or proposed for such.
When SSPC audits a project being done by one or more QP certified firms as a Joint Venture (JV), the audit counts as an audit for all the QP certified companies involvedin the JV. That is, if the audit is successful, all the JV QP companies audited would share this success. If the audit is not successful, the audit is unsuccessful forall QP firms involved. See Special Provisions "D" and "E. "In addition, SSPC reserves the right to audit a non-JV project being done by one or more of the joint venturecontractors. See Special Provisions "D" and "E" in program instructions and rules.
FAILURE OF AUDIT
Companies who fail the annual maintenance audit will be given 45 days after notification of audit results to submit a Corrective Action Plan and request that SSPCre-evaluate. SSPC reserves the right to withhold certification from firms who fail a maintenance or follow-up evaluation until a Corrective Action Plan (CAP) issubmitted and accepted by SSPC. SSPC may opt, in certain cases, to extend the company's certification status following acceptance of a CAP for a limited periodsubject to certain conditions.
Companies placed on suspension for failing a maintenance audit during their certification term will be formally notified in writing (e.g. by letter or email) of the suspension.
The company is given 45 days from notification to make corrective actions and be re-audited.
The company is asked to return original certificates.
The company is asked not to represent itself as QP certified, while the suspension is in effect
During a suspension period, SSPC will remove the company's name from the SSPC website search function of QP certified companies and post notice of the suspension onthe SSPC website. Companies will be formally notified in writing when a suspension is lifted, valid certificates will be reissued, and the company's name will bere-added to the appropriate list of certified companies.
Section 6: Verification and Acknowlegement of Principal Office
Note: By typing my initials and name on this form, I acknowledge that I have read and understand the documents listed below:
The QP Certification Program Application Form Instructions and Program Rules
The QP procedure set forth therein
The Disciplinary Action Criteria (DAC)
As a principal officer of the certified company, I indicate that we agree to abide by and be bound by the rules, regulations, and procedures set forth therein for the QP certification(s) held.
Principal Officer Name
Principal Officer Title (President, Chief Operations Officer, Chief Executive Officer) *
Please upload any additional files necessary
Please note that incomplete apps cannot be processed for renewal of your SSPC certification
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