Application Form (AB 29) - ABSA

APPLICATION FORCERTIFICATE OF AUTHORIZATION PERMITPursuant to Pressure Equipment Safety Regulation AR49/2006, Section 12(1)AB-29 (Side A) 2013-01Company Name:Mailing Address:Telephone No.: ( ) Fax No.: ( ) E-MailSite/Shop Address: Same as MailingPlease submit AB-29b to describe the scope and provide information for each additional shop location.Person Responsible for the administration of the Quality Management System:Name & Title: Tel. No.: ( ) Cell No. ( )I (we) wish to register for the following programs (check as applicable)E-Mail:New ; Renewal ; Revision: Name Change Ownership Change Use X Marks to Check Items as AppropriateLocation Change Additional Locations(s) Scope ChangeConstruction Repair/Alter Repair Only Mechanically*For Scope Change, enter all scopes to be covered under your program Shop Field Shop Field Shop Field Assembled1 PRESSURE VESSELSASME Section VIII-1ASME Section VIII-1 Highway TanksASME Section VIII-2ASME Section VIII-3Miniature Vessels in accordance with CSA B51Fuel Gas Cylinders Natural Gas/Hydrogen2 BOILERSASME Section IASME Section I Tube Replacement OnlyAssemble ASME Section I BoilersASME I Engineering ContractorASME Section IVASME Section IV Tube Replacement Only3 DIRECT FIRED HEATERSASME I Fired HeatersAPI 530 & B31.3 Fired HeatersEngineering Contractor CertificationAssemble Direct Fired Heaters4 INDIRECT FIRED HEATER COILSASME B31.3 Indirect Fired Heater Coils5 PRESSURE PIPINGASME B31.1 Power PipingASME B31.1 Power Piping Instrumentation TubingASME B31.1 Boiler External PipingASME B31.3 Process PipingASME B31.3 Process Piping Non Metallic Piping OnlyASME B31.3 Process Piping Instrumentation TubingASME B31.5 Refrigeration PipingASME B31.9 Building Services PipingASME B31.3 Highway Tanks Pressure PipingCSA Z662 Steam Pipelines6 FITTINGSCategory ACategory BCategory CCategory DCategory ECategory FCategory H7 SERVICING AND SETTING OF PRVS Shop FieldASME Certification: Assemble HV Assemble UV Assemble V Shop8 PQ TESTING OF WELDERSCovered under ASME Sec. VIII.1HotTappingMachine Welding Operators Shop FieldPressure Welders Shop Field9 OWNER-USER Program Please Submit form AB-512a10 INSPECTION COMPANIES Please submit form AB-515a11 OTHERS: SpecifyPage 1 of 4

Authorization currently held: (1) AQP- Expiry Date: (2) AQP- Expiry Date:AOQP- Expiry Date: ASVS- Expiry Date:Is the certification for: Own use ; External clientsAB-29 (Side B)ASME Code symbol stamps held or applied for: S ; H ; U ; U2 ; U3 ; UM ; PP ; A , V , UV , HVOther certificates held: R ; VR ; API ; ISO ; Other:Complete if Performing Qualification Testing of Pressure Welders and/or Machine Welding Operators:Scope of testing: For employees of your organization; For employees of another organizationPerson Responsible for the Performance Qualification Testing Program:Name & Title: Cell: ( )Telephone No.: ( ) Fax No.: ( ) E-Mail:ABSA Welding Examiner Certificate No.:Expiry Date:Complete if Servicing and Setting Pressure Relief ValvesSCOPE OF SERVICE APPLIEDSCOPE AUTHORIZED (ABSA use only)MEDIUMFrom NPS To NPS From NPS To NPSAIRLIQUIDSTEAMBy signing my name, I declare that the information provided on this application is true and correct and I confirm that I am awareof ABSA's fees as outlined in the attached schedule "3 YEAR CERTIFICATION PROCESS AND FEES".Applicant:Name of Company Officer(Please Print)Title:Signature of Company Officer:(This application will expire one year from the date of submission. The application fee is forfeited upon expiry of the application.)Application Fee $1075.00 is included. The application fee is non-refundable and is required for first time applicants and forrenewal applications. If this is an application for renewal you may provide us a purchase order and we will invoice you for thefee.Payment made by: P.O. #Date:OR provided Credit Card Information belowVisa ; MasterCard No. Expiry Date: OR Debit ChequeFOR ABSA USE ONLYThe Quality Management System for whichNew Expiry Date:(Company Name)seeks registration has been reviewed byABSA Safety Codes Officerand the following recommendation is made: Certificate to be issued not to be issued(Signature of ABSA Safety Codes Officer)(Date)Registration No.: AQP- AOQP- ASVS-The information you provide is necessary only for the administration of the programs as required by the Alberta Safety Codes Act and Regulations in the Boiler Discipline.Page 2 of 4

3 YEAR CERTIFICATION PROCESS AND FEESAB-29 Attachmentthe pressure equipment safety authorityAll Certificate of Authorization Permit renewals require submission of a new application for recertificationapproximately 6 months before expiry. The certification is renewed upon successfuldemonstration of the implementation of the quality program.Fees for Initial Certification, Interim Audits and Renewal of Certification are payable pursuant to the 'FeeSchedule for Delegated Functions' (Effective January 1,2013) and the Boilers Delegated AdministrationRegulation (Alta. Reg. 32/2002).Cheques are payable to ABSA .Mailing Address: Edmonton (780) 437 9100ABSA Calgary (403) 291-7070Quality Systems Certification Program Red Deer (403) 341-66779410 20 Avenue Grande Prairie (780) 538-9922Edmonton, Alberta T6N 0A4 Lethbridge (403) 394-1011Medicine Hat (403) 529-3514Fort McMurray (780) 714-3067Certification Process1 NEW PROGRAM CERTIFICATION:First meeting between ABSA QSCP Representative and the applicant to discussABSA requirements for registration of a new QMS, Safety Codes Act &Regulations and applicable Codes and Standards is held at no charge.FeesNo chargeIf the applicant decides to initiate the certification process, he/she is required to:(i) Submit the Application Form (Form AB-29).(ii) Non-refundable Application fee. $1075.00QMS review:- QMS Manual Review:A review of the manual will by conducted by an ABSA auditor.- QMS Implementation Review:An ABSA auditor will witness the implementation of the QMS to evaluateconformance and will prepare an audit report.TravelDocumentation review:Documentation review of the outstanding items (if any).Certificate of Authorization Permit:Upon successful review of the implementation of the program, a Certificate ofAuthorization Permit will be issued.2 PERIODIC AUDIT:Audit of the SystemABSA may schedule Periodic Audit(s) to verify continued compliance to the QMS.Audits may be conducted once or twice within the tenure (normally 3 years) of thecertification or as deemed necessary to confirm compliance. The ABSA auditorwill witness the implementation of the QMS to evaluate conformance and willprepare an audit report.Min. 4 hours @$140.00/hr.Additional hours @$140.00/hr.Time $140.00/hr. &expenses per ABSApolicy.Km @ current ABSAcharge.$140.00/hr.$140.00/ProgramMin. 4 hours @$140.00/hr. + expenses.Additional hours @$140.00/hr.Page 3 of 4

AB-29 AttachmentCertification ProcessTravel:3 RENEWAL OF THE CERTIFICATEApplication Form:Submit an Application Form (AB 29) and non-refundable Application Fee to initiatethe certification renewal process.QMS review:- QMS Manual Review:A review of the manual will by conducted by an ABSA auditor.- QMS Implementation Review:An ABSA auditor will witness the implementation of the QMS to evaluateconformance and will prepare an audit report.TravelDocumentation review:Documentation review of the outstanding items (if any).Certificate of Authorization Permit:Upon successful review of the implementation of the program, a Certificate ofAuthorization Permit will be issued.4 AUDIT CANCELLATION POLICYNotification for audit cancellation must be received 5 business days prior to the auditschedule date.5 CHANGE TO THE SCOPE OF THE CERTIFICATIONChange to the scope of certification may require an audit to certify a company foradditional scope items. Companies who wish to revise scope of the existingcertification must apply using an AB-29 Form.6 CHANGE OF LOCATIONChange of location may require re certification process similar to (3) above. Submit anApplication Form (AB 29) to initiate the re-certification process.7 CHANGE OF OWNERSHIP (No Name or Location change)Change of ownership may require audit of the facilities. Contact the nearestABSA office to discuss it with a QSCP Representative.Issuance of new Certificate of Authorization Permit.8 CHANGE OF COMPANY NAME(No Ownership or Location change)Change of company name will require issuance of a new Certificate of AuthorizationPermit.FeesTime $140.00/hr. &expenses per ABSApolicy.Km @ current ABSAcharge.$1075.00Min. 4 hours @$140.00/hr. + expenses.Additional hours @$140.00/hr.Time $140.00/hr. &expenses.Km @ current ABSAcharge.$140.00/hr.$140.00/ProgramFailure to provide sufficientnotice may result inminimum charge of 4 hours@ $140.00/hr plus anycommitted travel expensesassociated with thescheduled audit.Application Fee is notrequired.Fees chargeable per (3)above except ApplicationFee is not required.Fees chargeable per (3)above.Fees chargeable per (3)above except ApplicationFee is not required.9 DUPLICATE CERTIFICATE $140.00/ProgramPage 4 of 4