Certified Auto Glass Application Form

Program Application Form

Use the following form to apply for the Certified AutoGlass Service program. Before you apply, please read the program guide and be sure you are able to meet all of the qualification criteria.

Applicant Information

Company name:

CAG_Q001 *

Company name

Doing business as:

CAG_Q002

Shop DBA name (if different than company name)

Company address:

CAG_Q003 *

Number, street

CAG_Q004

Address Line 2

CAG_Q005 *

City

CAG_Q006 *

Province

CAG_Q007 *

Postal Code

CAG_Q008 *

Country

CAG_Q009 *

Business phone

CAG_Q010

Direct phone

Contact person:

CAG_Q011 *

First, last

Email address:

CAG_Q012 *

Website:

CAG_Q013

Website/URL

General Facility Standards

Full-Time Business – Are you in a permanent structure at a fixed location offering normal business hours (i.e. 8:30am-5:00pm – Mon-Fri)?

CAG_Q014 *

Garage Policy - Do you have a current garage liability policy?

CAG_Q015 *

Commercial Insurance - Do you have current commercial general liability insurance with a minimum $5 million in coverage?

CAG_Q016 *

Health & Safety – Do you have evidence of compliance with municipal, provincial, and national business regulations including health and safety? (i.e. registered with WorkSafeBC)

CAG_Q017 *

Health & Safety – Do you have both an approved eye wash station and approved first aid kit?

CAG_Q018 *

Disposal - Do you have proof of proper disposal of environmentally hazardous materials as required by applicable environmental laws?

CAG_Q019 *

Warranty - Do you have a written limited lifetime warranty?

CAG_Q020 *

Customer Area - Do you maintain a clean and orderly customer service area including reception and restrooms?

CAG_Q021 *

Mobile Service - Do you offer mobile service?

CAG_Q022 *

RO/Invoices - Do your repair orders/invoices contain a customer/rep signature, and identify the technician number who worked on the vehicle?

CAG_Q023 *

Basic Shop Requirements

Tools/Equipment – Select from the following to indicate the basic shop requirements you have:

CAG_Q025 *

Identify the windshield repair kit in use

Installation Products

Check all installation products in use in your facility:

ADAS

Please indicate your level of ADAS functionality.

ADAS System - Do you offer in-house ADAS services?

CAG_Q027 *

If yes, what ADAS system do you have in use?

CAG_Q028 *

System name (type "none" if you do not have a system)

OEM Info – How do you access OEM repair information?

CAG_Q029 *

ADAS Calibration – Do you retain documentation to support ADAS completion? (report/results confirming static/dynamic functionality)

CAG_Q030 *

Sublet ADAS Calibration – Do you retain documentation to support sublet ADAS completion? (report/results confirming static/dynamic functionality)

CAG_Q031 *

Customer to Manage ADAS Calibration – Where the customer is to manage their ADAS calibration needs (i.e. neither in-house or sublet) is the customer provided a release form that outlines their “Acknowledgement of Responsibility”?

CAG_Q032 *

Training - Personnel

Every technician performing glass repairs is required to be either a provincially licensed glass technician or a glass apprentice. Please indicate the following for each technician or apprentice:

CAG_Q033A *

Technician A: name

CAG_Q033B *

Technician A: Glass level attained

CAG_Q033C *

Technician A: ITA ID Number

Add a second technician?

CAG_Q034 *

YES
NO, I have only one technician to report

Certification:

I hereby certify that all answers I have provided herein are true and accurate to the best of my knowledge

CAG_Q044 *

Name of person completing application:

CAG_Q045 *