Application form for the British Columbia Salmon Restoration and Innovation Fund

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Application form for the British Columbia Salmon Restoration and Innovation Fund
(PDF, 349 KB)

British Columbia Salmon Restoration and Innovation Fund application for financial assistance
Project number (for official use)
a) Applicant profile
1) Application information:
Legal name of applicant:
Operating name, if different:
Mailing and courier address:
City/town, province, postal code:
Business number / GST number:
Website address:
Current number of full-time employees:
2) Primary contact:
Name:
Title:
Telephone number (business):
Other/cell number:
Fax number:
Email address:
3) Preferred language of correspondence:
English:
French:
4) Type of organization:
Corporation:
Sole proprietorship or partnership:
Not-for-profit organization:
Post-secondary institution:
Other (specify):
Briefly describe the organization's principal activities and objectives (products and/or services provided):
B. Project information
b) Project information
1) Physical location of the project (e.g., longitude and latitude, nearest city/town etc.):
2) Project name:
3) Project summary:
4) Estimated total project costs:
5) Amount requested from the British Columbia Salmon Restoration and Innovation Fund (BCSRIF):
6) Has the applicant received assistance from Fisheries and Oceans Canada (DFO) previously? Yes
No
7) Has the applicant made any financial or legal commitments for the project? Yes
No
8) If yes, provide details:
9) Estimated start date of project (yyyy/mm/dd):
10) Estimated completion date (yyyy/mm/dd):
It is the responsibility of the applicant to complete all required sections as accurately and as completely as possible. Failure to do so may preclude BCSRIF from considering the application.
C. Program alignment
c) Program alignment
(Provide details on how the proposed project aligns with BCSRIF program pillars and priorities.)
1) Which pillar does your project support? (select all that apply)
Innovation Yes
No
Infrastructure Yes
No
Science partnerships Yes
No
2) Which BCSRIF priority area(s) does your project address? (select all that apply)
Restoration, protection, and maintenance of healthy and diverse salmon populations and their habitats. Yes
No
Improved performance and sustainability of the commercial and recreational fisheries. Yes
No
Projects that improve the sustainability of the aquaculture industry to ensure the protection and conservation of marine ecosystems and wild fish populations. Yes
No
D. Ownership
d) Ownership
(Section reserved for companies and partnerships. Other applicants, go directly to section E.)
1) Provide information about the principal owners of the applicant.
Surname Given name Percentage of ownership Is the person active in the company? If yes, in what position/role?
Yes No
Ownership -
2) Provide the name(s) of any parent company, subsidiaries and of any affiliated or related business entities.
Name of the business City/town Nature of the relationship Contact person Telephone no.
D. GOVERNANCE AND MANAGEMENT
e) Governance and management
1) List the directors/members of the board and the key management personnel of the applicant.
Surname Given name Title / position Years of service Is the person active in the company?
Yes No
2) Provide the names of professional advisors DFO may contact to inquire about the applicant.
Service provider Name City/town Contact person Telephone no.
Accountant
Lawyer
Insurance company
Consultant
Other
3) Provide the name and contact information of the bank/financial institution DFO may contact to inquire about the applicant.
Institution City/town Contact person Telephone no.
Describe available credit:
F. Required information and documents
f) Required information and documents
(Include a complete project proposal and other relevant documents. All documents must be submitted in both paper and electronic format.)
Commercial applicants Yes N/A
Complete project proposal
Incorporation documents
Financial statements (current and last 2 years)
Supplier quotes (if applicable)
Copies of relevant permits and licences
Other relevant document (specify):
Not-for-profit and other applicants Yes N/A
Complete project proposal
Constituting / incorporating documents
Financial statements (current and last fiscal year)
Supplier quotes (if applicable)
Copies of relevant permits and licences
Other relevant document (specify):

Important notice: BCSRIF may require further information about the applicant to fulfill requirements. BCSRIF may also need to obtain consent to collect personal information from officials associated with the applicant. Failure to provide these, if requested, may preclude BCSRIF from finalizing the assessment of the application.

G. Disclosures
g) Disclosures
1) Environment Yes N/A
Is the applicant currently operating in conformity with environmental legislation?
Will the proposed project conform to environmental legislation?


2) Duty to consult    
Are there Indigenous groups or communities in or near the project area?
Could the project potentially impact Indigenous groups or communities?


3) Litigation    
Is the applicant involved in any relevant litigation, legal action, suit claim pending or underway or any other proceedings before any court, tribunal, government board or agency?
Are there any judgements outstanding against the applicant?




4) Material contracts  
Is the applicant in default under any contract or any financing arrangement?
5) Taxes and monies owing to the governement    
Is the applicant in arrears in the payment of any income, business or property taxes, sales taxes, or any other form of monies owed to the governement?
6) Other government funding    
Has the applicant received or sought any other government funding (including in-kind support) for this project?
If you answered “no” to question 1 or “yes” to any other question, please provide details:
 
H. Consent and certification
h) Consent and certification
  1. The information you provide on this form and on all attached documents, as well as any other information collected by or on behalf of Fisheries and Oceans Canada (DFO) to process applications for contributions, is collected under the authority of the Financial Administration Act and subsection 4.4(1) of the Fisheries Act for the purpose of administering the British Columbia Salmon Restoration and Innovation Fund (BCSRIF) and determining funding approval. The information may be used for policy analysis, research and/or evaluation, promotion and communication purposes and disclosed to other DFO programs, other federal institutions, and provincial and territorial governments for the purpose of administering and auditing the program. Failure to provide all the requested information may result in the application being rejected. The information provided to DFO will be treated in accordance with the Access to Information Act and the Privacy Act, and appropriate provincial and territorial legislation. You have the right to the correction of, access to, and protection of, your personal information under the Privacy Act, and to file a complaint with the Privacy Commissioner of Canada over DFO’s handling of your information. Personal information collected through the processing of your application is described in the Personal Information Bank for Grant and Contribution Initiatives (DFO PPU 047) and can be accessed and assessed for accuracy. For more information about the handling of your personal information, contact the DFO ATIP Secretariat.
  2. Projects for which an application for government funding is made are subject to an environmental screening and must comply with the environmental guidelines set out in the Canadian Environmental Assessment Act, 2012. A representative from Public Services and Procurement Canada may contact you to discuss the project.
  3. The names of successful applicants, the amount of funding approved and a description of the project are included in public records and disclosed on DFO's website in accordance with the government's proactive disclosure practices.
  4. DFO may contact any person listed in this application to inquire about the applicant.
  5. I certify that the information provided is, to the best of my knowledge and ability, complete, true and correct, and that thiswill apply to all information provided in the future in connection with the assessment of the project. Furthermore, I will promptly notify DFO if any of the information changes.
  6. I certify that financial assistance from DFO is a significant factor in the decision to proceed with this project.
  7. I authorize DFO to make any inquiries required, including obtaining corporate and business information about the applicant, to assess this application.
  8. I authorize DFO to make these inquiries of persons, firms, corporations, federal and provincial government departments, agencies, authorities, institutions and non-profit economic development organizations, and consent to the collection of information.
  9. I consent to the use of the information for determining funding approval, policy analysis, research and/or evaluation, promotion and communication of DFO programs and BCSRIF.

I have read and understood the above consent and certification. I voluntarily consent to the collection, use and disclosure of information as described, make the certification as stated and authorize the actions indicated.

(Please keep a signed copy of this form for your records.)

Signature of authorized official: Signed at (location):
Print name and title of authorized official: On this day of , 20
Contact information

Email: DFO.BCSRIF-FRISCB.MPO@dfo-mpo.gc.ca

1-833-615-2379 (toll-free)

Completed application forms, proposals in both paper and electronic copies (on a memory stick) and all supporting documents should be forwarded by mail or courier to:

BC Salmon Restoration and Innovation Fund
200-401 Burrard St
Vancouver BC  V6C 3S4