ࡱ> + bjbj|| DhDhQst8t8FFFFF$*F*F*FPzF|G4*F*J T:@T@T@THVZVV$gTУFV&V&V"VVУFF@T@T]bfbfbfVFF@TF@TbfVbfbf@֠@T ЛnWN6s0RWNl֠F֠VVbfVVVVVУУ^fVVVVVVVVVVVVVVVVt8X D: builders Prequalification scheme ABORIGINAL and REgional building contractors project specific upgrade program - application form The completed application form must be returned to the Finance Officer as advertised on Tenders WA The Applicant is: FORMCHECKBOX Not Prequalified FORMCHECKBOX Aboriginal Building Contractor FORMCHECKBOX Prequalified at Level  FORMTEXT       FORMCHECKBOX Regional Building Contractor Requests approval to tender on:Project Title FORMTEXT      Tenders WA request number FORMTEXT      Tender close date FORMTEXT      Prequalification requirement FORMTEXT      Finance Officer FORMTEXT       CERTIFICATION I certify that I:have read and understood all the information contained in clause 2.7 of the Builders Prequalification Scheme. that all the information provided in this application for a Aboriginal or Regional Building Contractor Project Specific Upgrade is true and correct in every detail and all required information has been supplied. I understand that:Finance will undertake a business risk assessment in accordance with section 2.10 of the Builders Prequalification Scheme, prior to the award of a contract and that Finance will generally not award a contract to a contractor that cannot demonstrate sufficient financial capacity. If I do not meet the financial capacity tests, then a suitable guarantor has been or can be identified. Refer to Business Risk Assessment for Prequalification and Tender Evaluation document. Name of Authorised Officer: FORMTEXT       FORMTEXT      (first name)(last name)Position held: FORMTEXT      Signature of Authorised Officer: FORMTEXT      (signature)Date: FORMTEXT      day of FORMTEXT       FORMTEXT      (day no.)(month)(year) BUSINESS PROFILE LEGAL ENTITY: (company or individual) FORMTEXT      TRUST NAME: (if relevant) FORMTEXT      REGISTERED BUSINESS NAME: (if different from legal entity) FORMTEXT      AUSTRALIAN COMPANY NUMBER (ACN) (if relevant): FORMTEXT      AUSTRALIAN BUSINESS NUMBER (ABN): FORMTEXT      BUILDING CONTRACTOR REGISTRATION NUMBER FORMTEXT      BUILDING PRACTITIONER REGISTRATION NUMBER FORMTEXT      DATE BUSINESS COMMENCED OPERATION: FORMTEXT      TYPE OF BUSINESS:Sole Trader FORMCHECKBOX Unincorporated Joint Venture or Partnership* FORMCHECKBOX tick appropriate box(s)Private Company FORMCHECKBOX Public Company FORMCHECKBOX Trustee++ FORMCHECKBOX Regional FORMCHECKBOX Aboriginal FORMCHECKBOX OtherPlease specify FORMTEXT      NOTE -* For businesses operating under a unincorporated joint venture or partnership, please attach a copy of the joint venture or partnership agreement ++ For businesses operating under a Trust arrangement, please attach a copy of the Trust Deed and any of its amendments PRINCIPAL PERMANENT OPERATIONAL OFFICEFloor Level: FORMTEXT      Unit No: FORMTEXT      Building Name: FORMTEXT      Street No: FORMTEXT      Street Name: FORMTEXT      Suburb/Town/City: FORMTEXT      State: FORMTEXT      Postcode: FORMTEXT      Finance may seek further evidence from the applicant in relation to the Principal Permanent Operational Office as defined at section 1.6 of the Builders Prequalification Scheme document. SIGNIFICANT BUILDING PROJECTS - Completed During Last FIVE Years List applicants significant building contracts. Projects where the applicant did not act as the Builder (ie Project or Construction Manager) are to be clearly identified in the description of contract field below. 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