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 5 only. All other QP Maintenance Applications should be submitted using the form found here.
QP Certification Being Renewed
Your Name (required)
Your Email (required)
A copy of this form will be sent to this email.
Section 1 Company Information
Technical/Quality Manager Name
Technical/Quality Manager Email
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.
Internal Audit: Provide, signed by T.Q.M. dated letter on company letterhead acknowledging that at least one internal QP5 audit has been completed in the previous 12 months. This is not to be confused with internal audits of your inspection projects.
Inspection Firm acknowledges responsibility to provide all information, in a timely manner, needed to schedule the annual audit, including QP5 job notifications and other projects where inspectors can be visited in the field.
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 the annual QP administrative maintenance fees and audit deposit, or will provide by due date 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 the last audit? If yes, provide explanation following notification requirements (per Special Provision A – See section IX of program rules)
Are any major changes in the company's organization planned?
Who Owns Your Company?
Is your company affiliated with an Industrial Coating Contracting firm or manufacturer or distributor of surface preparation or coating application equipment, or have an ownership interest in or owned in whole or in part by one of the above?
YesNo If yes, please explain in a separate attachment.
Please declare any conflicts of interest such as: 1.) Requiring a contractor your company is inspecting to purchase material or supplies from your company. 2.) Specifying for a customer a sole service product that you supply.
Federal Tax ID#/EIN (Provide change notification on IRS, or Secretary of State letterhead)
Section 3: environmental, Health and Safety Compliance Information
Provide copy of Worker's Compensation Experience Modification Rates (EMR), both Interstate & Intrastate, on insurance carrier's letterhead.
Attach current OSHA 300 and 300A forms
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 been involved with 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 applicant been involved with altering reports, documents, or test results on a project, as documented by facility owner or representative or other customer.
3. Has the applicant had allegations, Criminal charges or conviction of the owner, officers, directors or managing agents of the inspection firm for a felony related to coating inspection operations, whether the conviction arises by a finding of guilty by a judge or jury, a plea of guilty, ora plea of nolo contend ere (i.e. bribery)
4. Has applicant experienced misrepresentation or omission of information required for certification, as documented by SSPC.
5. Has applicant experienced 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 or other customer soliciting coating inspections services?
7. Has your company been disqualified from completing an inspection assignment? If yes, please explain in a separate attachment.
8. Has your company informed SSPC of any and all legal actions (local, state, or federal), or other notifications issued to it or an affiliated company for alleged or actual violations of regulations or laws pertaining to its operations, and the current status of each?
9. Is your company ISO 9001 certified, (or other Quality Management System Certifications)? Please list QMS certifications below:
10. 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.
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 control the 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 to revocation 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 involved in 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 for all 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 venture contractors. 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 SSPC re-evaluate. SSPC reserves the right to withhold certification from firms who fail a maintenance or follow-up evaluation until a Corrective Action Plan (CAP) is submitted 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 period subject 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 on the 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 be re-added to the appropriate list of certified companies.
Section 6: Verification and Acknowledgment 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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