First Advantage Canada Inc.

366 Adelaide Street West, Suite 200Toronto, ONM5V 1R9

Part 1 – CredentialingInformation Form(Required)

A.Company InformationCentral Community Support Services Network

Account Executive: Nancy Gummow

Agency Name: / DBA (if applicable)
Physical Address:
Website Address: / Main Phone:
Main Contact for Account Set Up: / Phone Number:

B.Billing Information:

Payment Options (please choose one)

Credit Card (Choose one: Visa ; MC ; Am Ex ) Card #: - - -

Exp. Date: /

By signing this authorization, I authorize First Advantage to charge my credit card for services rendered. I also certify that I am the cardholder as listed above and I am fully authorized to execute this transaction.

Signature: / Cardholder Name:

OR

FADV Invoice (to be paid by company check)

Do you require a P.O. Number on your invoice? No Yes P.O. Number:

Billing Contact / Address (Where should billing information, invoices, etc. be sent?)

Contact: / Title:
Check if address is same as address above / E-mail Address:
Street Address:
City: / Prov:
Phone #: / Fax #

C.Company Contacts

Executive Contact (Individual who is authorized to sign contracts and bind the company)
Contact: / Title:
Check if address is same as physical address above / E-mail Address:
Street Address:
City: / Prov:
Phone #: / Fax:
Account Management Contact(Individual who is authorized to make changes to the account: Add/remove users, set user permissions, etc.)
Contact: / Title:
Check if address is same as physical address above / E-mail Address:
Street Address:
City: / Prov:
Phone #: / Fax:

D.About Your Company

1. Business Type: Non-Profit Other:
2. Number of Years in Business:
3. Estimated Annual Volume of Requests: Volunteers: Employees:
4. GST Number: / Check here if business is GST Exempt:
5. Industry/Type of Business:Non-Profit - HealthCare
6. D&B Number, if known:
7. Number of Employees:

E.Please Read and Sign Below

The above information is submitted for the sole purpose of establishing service with First Advantage, and its affiliates. I hereby certify that the information is true, accurate and complete.

Any Customer who cannot be validated through the standard process may be required to provide additional documentation and/or may be required to operate on a credit card only payment arrangement.

______

Customer Authorized SignatureTitle Date

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Part 2 – Service Level Agreement (Required)

The CSS Network PROGRAM SERVICE LEVEL AGREEMENT –CANADA

This Agreement between ______, (“Customer”) and First Advantage Canada Inc. (“First Advantage”), is effective on ______, 20__, and includes any supplements that have been attached hereto which may be provided to Customer from time to time in accordance with this Agreement. This agreement is completed in conjunction with the overall requirements of the program with CentralCommunity Support Services Network and is subject to change as required by that program.

1. Description of Services. FIRST ADVANTAGE provides public record information as well as other proprietary data to Customers in compliance with all federal, provincial and/or territorial laws in Canada. Customer will use FIRST ADVANTAGE services and reports in accordance with all provincial, federal and territorial laws in Canada, and all applicable human rights and privacy legislation. Further, Customer shall request services via the following method(s):

  1. _X__ Customer Data Entry on Website

FIRST ADVANTAGE will deliver a written report of its findings which shall be deemed fulfilled upon the confirmed transmission of such Services.

FIRST ADVANTAGE will conduct the following services for the Customer:

Service / Package / Turnaround
Canadian Criminal / Pardoned Sex Offender Record Checks / Next Business Day

*information for additional services can be provided upon request.

Daily Submission Deadline: Customers are reminded that any files received after 3pm EST will be considered next business day.

2. Authorized Personnel and Disclosure of Reports. Customer will designate those persons authorized to request the Services and will be responsible for any services ordered by customers employees or personnel. Customer is specifically prohibited from reselling or disclosing the contents of any FIRST ADVANTAGE report to non-authorized users or third parties the customer determines does not have a substantial need to know, except in accordance with the terms of this Agreement or pursuant to federal, provincial and/or territorial laws in Canada.

  1. Fees

Amount / Notes
Account Set Up Fee / $100.00 / WAIVED
Priority Service Fee / 0% / Not applicable

Fees for Services. Fees will be assessed for each request in accordance with the table below (plus applicable taxes):

Pricing (CAD)
The CSS Network Package- Canadian Criminal Record Check & Pardoned Sexual Offender Record Check (Volunteer or Employee) / $23.99 / $22.99 / $21.99
1-1500 checks / 1501-2500 / 2501+
Pricing By Component
Available upon request

Administration Fee – in those cases where Customer requests services directly via the online platform, thereby creating a file in our system, we will levy a $10 administration fee after 3 business days on any file for which no consent statement is provided. This small fee is meant to reflect the internal costs of processing and tracking of the file as well as the resources required for the notification process.

Update to Services (Interim/Final Reports): In those cases where the information is not obtained within the standard turnaround time, FIRST ADVANTAGE will issue an Interim Report and continue to make all reasonable efforts to obtain the information and then issue the results as they become available. Data will be updated on the system as each outstanding service is completed and will be reflected as “final” once the Final Report has been issued.

Additional Fees: In those cases where additional fees are required (overseas, translation, school/employer charges etc.), please follow the current process:

i__X Request confirmation from Customer for each fee before adding to file

ii____ Pre-approve additional costs up to $___

iii____ Pre-approve additional costs as per the following schedule XXX

iv___ N/A

Payment terms shall be net thirty (30) days following receipt of FIRST ADVANTAGE’s invoice. Receipt of FIRST ADVANTAGE’s invoice shall be deemed to be on the third business day following the date of mailing of the invoice by FIRST ADVANTAGEThe standard invoicing process is monthly, at month end. Interest penalties may be applied after invoices reach 60 days outstanding.

FIRST ADVANTAGEand Customeragree that FIRST ADVANTAGEretains the discretion to change its fees upon provision of thirty (30) days written notice. Should the Customer not agree to the newly proposed fees then the Customer shall provide FIRST ADVANTAGEwith at least thirty (30) days written notice that it no longer wishes to continue utilizing FIRST ADVANTAGEservices and hence, wishes to terminate this Agreement.

  1. Length of Agreement. The terms of this agreement shall be in effect for a period of 3 year (s) from the effective date listed above and, thereafter, until amended in writing on thirty (30) days notice by either party. Therefore, if Customer fails to give FIRST ADVANTAGE thirty (30) days written notice prior to the end of the abovementioned one (1) year period, this contract shall automatically renew for consecutive one (1) year periods.
  1. Termination. Either party shall have the right to terminate this Agreement, with or without cause and without penalty upon sixy (60) days’ prior written notice. FIRST ADVANTAGE shall be entitled to receive compensation for Services completed as of the termination date. Paragraphs 3 and 5-17 shall survive termination of this agreement.
  1. Exclusivity. Customer hereby agrees to exclusively use First Advantage Canada Inc. for all services outlined in paragraph 1 above for the duration of this Agreement.
  1. Confidentiality. First Advantage Canada Inc. and Customer agree that the provision of background checks and exit interviews involves the use and exchange of information that is confidential. First Advantage Canada Inc. agrees to use the confidential information solely for the purpose of conducting its background checking of candidates for employment and that it will protect the confidentiality of the information in the same manner that it protects its own confidential information. Further, First Advantage Canada Inc. agrees thatit will restrict access to confidential information to those First Advantage Canada Inc. employees having a need to know such confidential information for the purpose of performing its obligations under this Service Agreement, that it will not disclose confidential information to any third party, except as required by law; andit will comply with all applicable privacy legislation in Ontario in the course of providing the services hereunder.
  1. Warranty. Customer understands and agrees that FIRST ADVANTAGE neither warrants, vouches for, nor authenticates the reliability of the information provided hereunder except that the information has been accurately reported from the source.
  1. Indemnification and Hold Harmless. (a) Customer agrees that it shall be responsible for any and all actions that it takes based on any FIRST ADVANTAGE Service/Report. Customer shall defend, indemnify and hold FIRST ADVANTAGE and/or its subcontractors harmless from any and all losses, claims, demands, liability, causes of action, judgments, costs and attorneys’ fees arising out of this Agreement, except to the extent that FIRST ADVANTAGE and/or its subcontractors are negligent or fail to comply with any federal, provincial and/or territorial laws in Canada. Customer hereby agrees to hold FIRST ADVANTAGE and/or its subcontractors harmless on account of any expense, cost or damage resulting from Customer’s, or its employees’, agents’ and/or independent contractors’ publishing of any information provided by FIRST ADVANTAGE contrary to the terms of this Agreement or applicable laws, rules and/or regulations, (b) FIRST ADVANTAGE shall indemnify and hold Customer harmless, and its agents and employees, from any and all losses, claims, demands, liability, judgments, costs and attorney’s fees arising out of FIRST ADVANTAGE’s negligence in providing the Services/Report, (c) Notwithstanding any other term or provision of this Agreement, to the contrary, in no event shall either party or its officers, agents or employees be liable for loss of profits or for indirect, special, incidental or consequential damages arising out of or related to the performance of this Agreement. Customer acknowledges that any client specific questions have not been reviewed by any and all Human Rights Commissions. Neither party shall be liable for any indirect, incidental, contingent, consequential, punitive, exemplary, special or similar damages, including but not limited to, loss of profits or loss of data, whether incurred as a result of negligence or otherwise, irrespective of whether they have been advised of the possibility of the incurrence of any such damages. Neither party’s liability damages incurred in connection with services provided pursuant to this agreement shall exceed the amount of fees paid by the client to First Advantage Canada for services provided under this agreement.
  1. Customer Certification. Customer agrees, certifies and warrants to FIRST ADVANTAGE as follows:

Customer will not request or procure any Service/Report for employment purposes unless, prior to requesting such, on each occasion customer has obtained a written authorization from the consumer specifically authorizing the procurement of a consumer and/or investigative consumer report by that Customer. Should any Customer take adverse action against a consumer, based in whole or in part on a consumer report, Customer shall provide the consumer FIRST ADVANTAGE’s name, address and telephone number. Customer also hereby certifies and agrees that it will not use any FIRST ADVANTAGE Service/Report in violation of any applicable federal, provincial and/or territorial laws in Canada including any human rights and privacy legislation. Customer acknowledges and agrees that FIRST ADVANTAGE may conduct random compliance audits to ensure conformance with this Agreement.FIRST ADVANTAGE also retains the right to approve consent statements being used for any and all services they are required to deliver.

MISCELLANEOUS

11. Entire Agreement. Except as otherwise provided herein, this Agreement constitutes the entire agreement between the parties and supersedes all prior agreements and understandings. This Agreement may be amended or modified only by a written agreement. All documents or schedules referred to in this Agreement are incorporated herein by reference.

12. Force Majeure.FIRST ADVANTAGE shall not be responsible for any delay in performance or failure in performance of any obligations pursuant to this agreement if such delay or failure is the result of causes beyond the control and without negligence of FIRST ADVANTAGE. Such causes shall include, without limitation, acts of God, strikes, lockouts, riots, insurrections, civil disturbances, sabotage, embargoes, blockades, acts of war, acts or failures to act of any governmental or regulatory body (whether civil or military, domestic or foreign), governmental regulations superimposed after the fact, communication line failures, power failures, major hardware or software failures, fires, explosions, floods, accidents, epidemics, earthquakes or other natural or manmade disasters, and all occurrences similar to the foregoing.

13. Counterparts. This Agreement may be executed in one or more counterparts and the several executed counterparts will both be considered one.

14. Attorney’s Fees. Should any court action be filed by any party as a result of the breach of any term of this Agreement, each such party shall pay its own attorneys’ fees and costs. The prevailing party shall be entitled to an award of reasonable attorney fees and costs in any action or claim brought for enforcement of this agreement.

15. Successors and Assigns. This Agreement shall be binding upon and inure to the benefit of the respective parties and their permitted assigns and successors in interest.

16. Severability. Should any term or provision hereof be deemed invalid, void or unenforceable either in its entirety or in a particular application, the remainder of this Agreement shall nonetheless remain in full force and effect.

17. Waiver. No waiver of any provision of this Agreement shall be valid or binding unless in writing and signed by the other party.

In Witness whereof, the parties have entered into this Agreement as of the date set forth:

Authorized Representative of the Customer:

Name

Title

Signature Date

Customer Name ______

Mailing Address ______

Authorized FIRST ADVANTAGE Representative:

Name

Title

Signature______Date ______

First Advantage Canada Inc.

366 Adelaide Street West, Suite 200 Toronto, ONM5V 1R9

Part 3 – Online Account Set Up Details (Required)

Account Information

Account Number: / (to be provided by First Advantage)
Client Group: / YES - The CSS Network
Accounting Code: / (to be provided by First Advantage)
Market Source: / The CSS Network Referral Program
Duplicate Check / YES
Email Confirmation Upon
Receipt of Orders / YES
Data Entry / To Be Done by Customer
Show Communication Logs / YES
Method of Reporting / Customer Retrieval from Website
Deliver Partial Reports / NO
Pre-approve Surcharges / NO

Authorized User Information

The following contacts will be setup to access to secure online system – please ensure they are suitable for this task – COMPLETE ONE SECTION FOR EACH USER.
Contact Name / Title:
Phone Number1 / Phone Number2
Email Address
Access Level: / SUBMIT AND VIEW RESULTS (SUPER USER) OR
VIEW ONLY RESULTS FOR MY ORDERS
Contact Name / Title:
Phone Number1 / Phone Number2
Email Address
Access Level: / SUBMIT AND VIEW RESULTS (SUPER USER) OR
VIEW ONLY RESULTS FOR MY ORDERS
Contact Name / Title:
Phone Number1 / Phone Number2
Email Address
Access Level: / SUBMIT AND VIEW RESULTS (SUPER USER) OR
VIEW ONLY RESULTS FOR MY ORDERS
Contact Name / Title:
Phone Number1 / Phone Number2
Email Address
Access Level: / SUBMIT AND VIEW RESULTS (SUPER USER) OR
VIEW ONLY RESULTS FOR MY ORDERS

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