Application Form - Contracting Firm

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Phyllis Randall
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1 Application Form - Contracting Firm This form is for civil construction and general contracting companies to apply for membership of Civil Contractors New Zealand Company s details CCNZ Branch you want to join? Company name: Trading Postal Address: Suburb: Post Code: Physical address: Suburb: Post Code: City: Fax: Contacts: It is important that we reach the right people in your company. We need the following details so that you receive maximum benefit from your membership with us. Please fill in all sections. If only one contact, please tick here Primary contact: Secondary contact: Technical contact: Health & safety contact: Administration/accounts contact: CCNZ Website contact 1

Company name: Trading Postal Address: Suburb: Post Code: Physical address: Suburb: Post Code: City: Fax: Contacts: It is important that we reach the right people in your

2 Additional information To help us provide what your company needs, please take the time to tick your preferences below. There is space available below if you wish to list more items. What do you want from membership with Civil Contractors New Zealand? Meet other contractors Meet suppliers to industry Roadshows/seminars Awards/competitions To receive industry news Roading Information Attend social events Attend conference Technical advice Benefits/schemes/discounts Compliance Give back to industry A presence on website Networking opportunities Publications Training How did you hear about us? Internet/Google Contracting member Associate member Magazine advert Local government mag advert CCNZ employee CCNZ website Conference Other Recruited by: Contractor Magazine Membership with CCNZ entitles you to one complimentary copy of the Contractor Magazine, who is the best person to mail this to? Contractor Magazine complimentary copy: tick here if same as primary contact Address: City: Title: Suburb: Post code: Additional subscriptions Contractor Magazine You can subscribe for additional copies of the magazine for $72.00 for 11 issues pa. We will ask the Contractor Magazine to contact you, are you interested? YES NO Subscription category for CCNZ Membership Number of Employees: Your CCNZ membership subscription is based on the total turnover of your parent company including subsidiary companies and or business units. Subsidiary companies qualify for membership under the umbrella of the parent organisation membership (see CCNZ rules for details). See over the page for more information. Please tick one. Owner/operator - $1 million $1 - $5 million $5 - $10 million $10 - $25 million Over $25 million 2

Meet other contractors Meet suppliers to industry Roadshows/seminars Awards/competitions To receive industry news Roading Information Attend social events Attend conference Technical advice

3 Company Services The services you offer will be listed on the CCNZ website where you can also build a comprehensive public profile page about your company. This includes your logo/contact details/services on offer/accreditation plus much more. Please tick which service/s relate to your company. Earthmoving Drilling and blasting Dam construction Effluent ponds Excavation Fill disposal GEO tech - gabions GEO tech - geotextiles GEO tech - groynes Land Clearing Land development Rock work Agri Arboriculture Drainage Fencing Irrigation Land clearing Spraying Vegetation control Weed control Fertilisers Drilling Culverts Flood control Horizontal direction drilling Irrigation Marine Micro-tunnelling Open drains Pipe jacking Pipe welding Storm water Tunnelling Waste-water/sewer Waste-water/shallow Waste-water/treatment Water reticulation Skills Construction management Design &build Maintenance Project management Quarry Drilling and blasting Production Stripping Landscaping Driveways Earthmoving Kerbing Maintenance Paving Retaining walls Utilities Power reticulation Utilities - General Trenching Cable Lay Duct Repair Equipment Installation Structure Blasting - explosive Pump chambers Bridge building Bridge demolition Reservoirs Retaining walls Drainage Culverts Flood control Horizontal direction drilling Irrigation Marine Micro-tunnelling Open drains Pipe jacking Pipe welding Storm water Tunnelling Waste-water/sewer Waste-water/deep Waste-water/shallow Waste-water/treatment Water reticulation Trenching Environment Flushing Graffiti removal Retention ponds Silt & sediment control Water blasting Water testing Laboratory services Transport Cartage Cranes Freight Heavy haulage Plant hire Volume measurement Waste collection Winching Concrete Cutting Insitu Paving Placing Precast Repairs Treatment Crushing Production Roading Bitumen/Asphalt Drainage Earthworks Excavation Fencing Fill deposit Guard rail Kerb and channel Maintenance - large Maintenance - small Paving Services Traffic management Tunnelling Sealing Road Markings Geotechnical Difficult Access Drill & Blast Inclined Drains Mine Stability Rockfall protection Self-drilling Anchors Slip Remediation Slope Stabilisation Soil Nails Stand Anchors Maintenance Maintenance -city Maintenance - highway 3

Earthmoving Drilling and blasting Dam construction Effluent ponds Excavation Fill disposal GEO tech - gabions GEO tech - geotextiles GEO tech - groynes Land Clearing Land development Rock work Agri

4 Subsidiaries/Branches Does your company have any subsidiaries or branches attached to the parent company? Branches Does your company have any subsidiaries or branches attached to the parent company? Subsidiary company/s Must be 100% owned by the parent company above Turnover of all subsidiaries must be included in the subscription turnover category. Include all relevant people that should receive information from CCNZ. Please tick if applicable to your company. Branches - Yes we have branches and want them included in our membership Subsidiary company/s Yes we have subsidiary company/s and wish to include them in the above membership Method of Payment Current list attached (include region, company name, contact name, address, phone, mobile, ) Contact national office on for subscription amount, an invoice will be provided. Please indicate your preferred payment option: Cheque Credit Card Direct Credit Direct Debit Bank Account: (please include company name and invoice number as a reference) (Visa/MasterCard) circle one Credit Card Number: Company : Expiry Date mm/yy Name of Card Sign: Amount: $ Membership Declaration The undersigned hereby declares that the information supplied is true in substance and in fact, and authorises Civil Contractors New Zealand (CCNZ) to verify, where and when necessary, claims and/or estimates made. The undersigned has read and understood this declaration, CCNZ s rules, and CCNZ s code of ethics. The undersigned hereby applies for membership with CCNZ and its branches and agrees to abide by CCNZ s rules and code of ethics, as may be amended from time to time by CCNZ. The undersigned understands CCNZ membership is constant and must be cancelled in writing with one calendar month notice of the intention to resign. The undersigned is aware that the undersigned is liable for all subscriptions and levies outstanding and unpaid as at the date of the expiry of the notice. The undersigned also gives permission to CCNZ to display my/our contact details on the CCNZ website directory and provide contact information to all members from time to time. Signed: Date: Position: Please note this application does not constitute acceptance of membership. Civil Contractors New Zealand Margan House, 21 Fitzherbert Terrace, Thorndon 6011 P O Box , Wellington 6144 Ph: Fax: info@civilcontractors.co.nz 4

Include all relevant people that should receive information from CCNZ. Please tick if applicable to your company.

5 Company Profile Tell us a bit about your company, your vision, your people, your history and what you are most proud of. You may have an opportunity to deliver part of this to your peers at your first branch meeting this may help in marketing your services. Company History What is your history, how long have you been trading? (are you a family company, when established, or are you a new company, what motivated you to start trading). What are you most proud of? Tell us about your company s highlights, successes, awards you have won? Let us share in your success. Tell us about your firm s interests, capabilities and aspirations? What are your abilities, services, activities and aspirations. Company Vision Do you hold a vision, share it with us, tell us how you came to adopt this vision, and tell us how we can assist with this? Company name: Position: Surname: Date: 5

Company History What is your history, how long have you been trading? (are you a family company, when established, or are you a new company, what motivated you to start trading).

6 Company Plant and Resource List If you are interested in being available for your local council in a Civil Defence Emergency or for the public to search for your services in our website, please take the time to fill in your resources and plant below. Attach your existing list if already produced. Equipment Description Example: ZX200 20T Excavator x 3 Usage Bulk excavation, Silt control, Clearing, Rock Breaking 6

time to fill in your resources and plant below. Attach your existing list if already produced.

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