Western Innovation (WINN) Initiative Application

Transcription

1 Western Innovation (WINN) Initiative Application Part Two You will have approximately 15 business days to complete part two of this application once you receive the invitation. Before submitting this application, please ensure you have answered all questions that are applicable to your project. Unanswered questions cannot be assessed by Western Economic Diversification Canada. PART ONE CONFIRMATION 63. Has any of the information you submitted in the Expression of Interest changed? * Yes No 64. If yes, provide the question number(s) and details on the information that has changed. (Maximum 1000 characters including spaces) * PROJECT COSTS 65a. Project Costs (All costs will be validated) * Amount * Total Project Costs (Must equal total project funding required): 65b. The following documents are required for WD to assess your submission. They must comply with the information requirements as outlined in the Applicant Guide. IT IS RECOMMENDED THAT YOU REVIEW THE APPLICANT GUIDE INSTRUCTION LOCATED AT Financial Statements* Forecasted Income Statements and Cashflow* MANAGEMENT 66. Based on your responses to question 47 please provide details on your management s abilities and commercialization experience. (Maximum 500 characters including spaces) 67. In reference to question 48a provide details on the Board s composition, as it pertains to individuals experience and expertise, the Directors relationship with management, and the Board s responsibilities? (Maximum 1000 characters including spaces) * 1 of 8 Aussi disponible en français.

2 Explain how the strategic or business partnerships selected on question 49 will assist in supporting your project. (Maximum 1000 characters including spaces) * 67 TECHNOLOGY READINESS LEVEL 69a. Refer Back to the readiness level you chose in part 1. Level 9 - Actual technology proven through successful deployment in an operational setting. Level 8 - Actual technology completed and qualified through tests and demonstrations. Level 7 - Prototype ready for demonstration in an appropriate operational environment. Level 6 - System/subsystem model or prototype demonstration in a simulated environment. Level 5 - Component and/or validation in a simulated environment. Level 4 - Component and/or validation in a laboratory environment. Level 3 - Analytical and experimental critical function and/or proof of concept. Level 2 - Technology concept and/or application formulated. Level 1 - Basic principles of concept are observed and reported. 69b. Describe why you believe your technology is at the previously stated readiness level. Include information on all certifications, licenses, and approvals that have been obtained and those that are outstanding. (Maximum 1000 characters including spaces) * 70. If your organization answered Yes to question 52 please attach your written endorsement or review of the technology. Attachment PROJECT TIMELINES 71. Indicate project milestones that occur between the proposed project funding start date and the proposed project end date. Milestone * Completion Date * 72. Comments on project milestones. (Maximum 500 characters including spaces) * MARKET 73. If your organization answered yes to question 54, please attach your independent market assessment. [] Attachment 74. Provide details of who your competition is and where they operate. (Maximum 1000 characters including spaces) * 2 of 8 Aussi disponible en français.

3 12 BENEFITS 75. Please estimate the following direct economic benefits to your company resulting from this project. Note: these should be measured from the project funding start date to one year following the project completion date.* Complete all 75a. Total new jobs created in Canada Amount * 75b. New HQP jobs created in Canada (Of total new jobs, how many require highly qualified personnel?) * 75c. Total new sales * 75d. New foreign investment in Canadian operations * 76. Provide an estimation of any additional economic benefits that may accrue in Canada. ( Maximum 1000 characters including spaces) 1 TECHNOLOGY INTELLECTUAL PROPERTY 77. From the list below, please select the choices that best reflect the patent status and patent ownership status of your technology, including other IP protection that applies: 77a. Select the response that best applies to the IP related to this project: (Select best fit) * IP is owned by the applicant organization IP is licensed by the applicant organization IP is not owned or licensed by the applicant organization 77b. Patent Status in Canada: (Select best fit) * None filed 1-3 granted Filed pending approval More than 3 granted 77c. Patent Status International: (Select best fit) * None filed 1-3 granted Filed pending approval More than 3 granted 77d. Other IP protection: (Select best fit) * None not applicable Trademarks Other Trade secrets Copyright 78. Provide a brief description of your organization s IP strategy indicating why this strategy is appropriate for your technology. (Maximum 1000 characters including spaces) * TECHNOLOGY 79. What further development or technical activities are required to bring the technology to market? (Maximum 2000 characters including spaces) * 3 of 8 Aussi disponible en français.

4 80. Describe the technical expertise in your project team including education, qualifications and experience of your technical staff and the organizational structure of the team. Include the track record of key team members in similar projects. (Maximum 4000 characters including spaces) * Describe the additional technology resources (e.g. equipment, external contractors, partnerships, etc.) that are in place to complete the project and, if applicable, what additional resources/partnerships are required to successful carry out the project? (Maximum 2000 characters including spaces) * 82. Provide a technical description of your technology. This description should clearly describe the functions, key specifications, and outputs that best represent your technology. (Maximum 1000 characters including spaces) * 4 of 8 Aussi disponible en français.

5 82a. You may attach a 1 page document to assist in this description (schematic, process diagram, design document etc.) [] Attachment 83. Provide evidence, including measured, quantified or observed data that prove that the specifications described above were achieved. If the evidence was verified by a third party, please provide references. (Maximum 1000 characters including spaces) * 84. Describe how your technology will function in a planned operational setting. (Maximum 1000 characters including spaces) * 85. Describe the features and benefits of your technology. Provide a high level comparison between these and those offered by your competition. (Maximum 1000 characters including spaces): * Does your project involve development and/or technology demonstration * If yes, answer the following three (3) questions. 86a. Technology development roadmap indicating current position. (Maximum 1500 characters including spaces) Yes No 5 of 8 Aussi disponible en français.

6 86b. Project plan including key activities, duration, and resources in your technical workplan. (Maximum 2500 characters including spaces) c. You may attach a 1 page document (Gantt chart) to help describe the plan. []Attachment 86d. For technology that requires commercial production, has a limited scale pre-product run been carried out? Describe all quality control procedures and production standards that are in place. Describe how you will manage parts and inventory. (Maximum 4000 characters including spaces) 6 of 8 Aussi disponible en français.

7 What are the risks associated with bringing the technology to market, including any technical barriers to implementation, and other issues (e.g. environmental, safety of application, etc.)? What is your plan to mitigate the risks? (Maximum 2000 characters including spaces) * 7 of 8 Aussi disponible en français.

8 AUTHORIZED OFFICIAL OF THE APPLICANT ORGANIZATION ACKNOWLEDGEMENTS In reference to Part Two of this application: On behalf of the Applicant Organization, I hereby acknowledge and agree that: This application does not constitute a commitment from Western Economic Diversification Canada (WD) for financial assistance. I have read the WINN application process including the mandatory eligibility criteria located at Project costs incurred by the Applicant Organization in the absence of a signed funding agreement with WD are incurred at the sole risk of the Applicant Organization and that any such costs may not be considered eligible for WD assistance. Any person who has been lobbying on behalf of the Applicant Organization to obtain a contribution as a result of this application is registered pursuant to the Lobbying Act and was registered pursuant to that Act at the time the lobbying occurred. The Applicant Organization has not, nor has any other person, corporation or organization, directly or indirectly paid or agreed to pay any person to solicit a contribution arising as a result of this application for a commission, contingency fee or any other consideration dependent on the execution of an Agreement or the payment of any contribution arising as a result of this application. The information provided by the applicant on this application and in all supporting documentation is collected under the authority of the Western Economic Diversification Act. This information will be treated in accordance with that Act and with the Access to Information Act and the Privacy Act. These laws govern, protect and limit the collection, use and disclosure of personal and confidential information by federal government departments and agencies. Information provided to WD is secured from unauthorized disclosure and use. WD acknowledges an individual s rights to privacy of their information, and personal information provided on this application is described in the Personal Information Bank entitled Grants and Contributions (G&Cs) Programs, number WED-PPU-055. For further information about WD s information holdings and your rights under the Access to Information Act and Privacy Act, consult WD s Info Source publication at I authorize WD, its officials, employees, agents and contractors to make enquiries of such persons, firms, corporations, federal, provincial and municipal government departments/ agencies, and non-profit, economic development or other organizations as may be appropriate, and to collect and share information with them, as WD deems necessary in order to assess this application, to administer and monitor the implementation of the subject project, and to evaluate the results of the project and related Programs. 88. I have read and agree with the above applicant acknowledgements and certify that all statements and information furnished in this application are true, complete, and correct to the best of my knowledge. * 89. Name: * 90. Title: * Date: * Signature: * Save Instructions: You can complete this application form in more than one session by using the Save button at the top of the application form. An will be sent to the Project Contact identified on the form. The Project Contact must save this as it is the only way you can retrieve your saved application. This includes a link to your saved application and instructions on creating a GCKEy which is required to access your saved application. Validate/Submit Instructions: 1. Save a final version of your application using the Save button at the top of the application form. 2. Print a copy for your records. 3. Select the Validate/Submit button at the top of the application form to formally submit your online application to WD. Once the validation of your application is complete you will have to select a second Submit button. 4. The Project Contact will receive a confirmation upon successful submission. If you do not receive this confirmation within 24 hours of submitting please contact a WD Regional Office. A saved application that is not formally submitted will be considered incomplete and will not be considered for funding. 8 of 8 Aussi disponible en français.