Membership Application

Afro Canadian Contractors Association
3150 Ridgeway Drive Unit 40 Mississauga,
Ontario, L5L 5R5 Telephone: (647) 424-2230
E-mail: [email protected]

The Afro Canadian Contractors Association (the “Association”) is a professional membership based not-for-profit organization. Membership with the Association is inextricably linked to the Associations mandate of increasing the presence of Black contractors in the Canadian construction industry. It is in the spirit of the mandate that the membership base shall consist of persons who self-identify as black and are of African descent to ensure the benefits of membership permeates the black community. Membership applies to the individual applicant and does not extend to any business or organization to which the applicant is affiliated.

As a note to all applicants, please be reminded that the Association takes reasonable steps to verify information provided in support of any application. Applicants are responsible for ensuring the accuracy and validity of all information provided. During the assessment of an application, or at any later date, if the Association determines that false, misleading or incorrect information was provided, an application may be cancelled, revoked and/or refused.

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Note: While only the fields marked with an asterisk [*] are required, a complete application is required for membership consideration.

SECTION A - MEMBER IDENTIFICATION

Membership Class:

Platinum Gold Associate Affiliate

1. All Applicants

Have you attended our Introduction Info Session?

Yes No

If Yes, what date did you attend?

First Name *

Last Name *

Title/Occupation

Primary Email (Can be same as Company Email)*

Company Email *

Company Telephone *

Company Name *

Company Website

Business Type

Sole Proprietor Partnership Incorporation

Corporation Number or Business Identification Number

Years in Business

Street Address

Unit Number

PO Box

City/Town

Province

Postal Code

Service Area

2. Contractors

What is your contracting category?

Home Builder General Contractor Subcontractor Renovator Specialty Contractor Handyman

How many years have you been in the business?

Sector

ICI Residential Civil

Trade

Trade/Contractor License No.

Union Affiliation

Yes No

Project Capacity

Less Than $100,000
$100,000 - $1,000,000
$1,000,000 or Greater

Describe Your Scope of Work

How many projects can you manage at the same time?

General Liability Insurance

Not Insured
$2,000,000 $5,000,000 or Greater

WSIB/WCB

Yes No

Number of Employees

3. Associates or Affiliates

What is your profession?

Project Management Real Estate Service Provider Supplier Tradesperson Other:

Area of Expertise

What geographical areas do you serve?

SECTION B - MEMBERSHIP EXPERIENCE

4. ACCA Services

What benefits are you looking for in becoming a member?

Networking
Professional Development
Project Leads
Advertising
Website Development
Referrals
Workshops
Social Events
Bid Preparation
Industry Exposure
Mentoring
Group Benefits Discounts
Other:

Would you like to volunteer your time?

Yes No

If Yes, how many hours per month can you contribute?

SECTION C - TARGET DEMOGRAPHICS

5.Underrepresented Group

All Applicants

Do you identify yourself with any of the following? (Check all that apply)

Woman Youth Black Indigenous Racialized Newcomer Veteran

Contractors

Is your company at least 51% Black owned and/or operated?

Yes

SECTION D - SUPPORTING DOCUMENTATION

6.Supporting Documents

The following are to be submitted along with your application

Check all that apply (Max 10MB each)

Contractors

Copy of Government Issued Photo ID
Copy of Certificate of Incorporation OR Master Business License
Copy of WSIB Clearance Certificate OR WCB Clearance Letter

Associates and Affiliates

Copy of Government Issued Photo ID

SECTION E - DECLARATIONS AND CONSENT

7. Declarations of Accuracy and Consents for Application

Certification of Accuracy of Information Provided
I declare that by signing below, all information I have provided or will provide to the Afro Canadian Contractors Association (the “Association”) in the future in or in connection with this application is true, accurate and complete. I agree to immediately notify the Association regarding any future changes to information I have provided.

I acknowledge that if I provide false or misleading information or documents to the Association, or fail to provide information or documents requested by the Association:

  • I may be denied membership or my membership may be revoked at a later date.

Consent

I consent that the Association may contact, request information, documents or records from, and provide information to, other sources including:

  • governing, regulatory, self-regulatory, apprenticeship or trades bodies, authorities, agencies or officials;
  • publicly available sources under applicable laws or regulations;
  • any other relevant sources..

I consent that the Association may collect, use, and disclose any information provided in or in connection with this application for the following purposes:

  • processing this application;
  • administering my file or membership with the Association;
  • enforcing the Association's by-laws;
  • conducting policy analysis, evaluation and research related to the black community's engagement in the construction industry;
  • as required or permitted by law

I consent that all information, documents or records requested by the Association for the above-noted purposes from other sources may be provided to the Association.In addition, I consent that the Association may collect, use and disclose my personal information and confidential information provided in or in connection with this application as provided above, as well as in accordance with the Association's privacy policy available at https://www.accacan.com/privacy and as permitted or required by applicable laws or regulations.

Signature *

Date (yyyy-mm-dd) *