Canadian Pacific Railway Company - TCRC Moose Jaw

1 Canadian Pacific Railway Safety Footwear Purchase Authorization Form DATE: EMPLOYEE FULL NAME: EMPLOYEE NUMBER: UNION: REQUEST FOR SUBSIDY. Does the employee above qualify for a subsidy: YES NO. What is the total price of the safety boots: $. For TCRC (MWED, RTE) the subsidy is of the price of the boots. Maximum subsidy is $ per pair -- Two purchases per year For IBEW, CAW and TCU/USWA the maximum subsidy is $ within each 18. months PAYROLL DEDUCTION. Does the employee require payroll deduction: YES NO. Price before tax: $ Total Cost: $. Full name of and address of supplier where purchased (must be an approved vendor): Number of deductions requested by employee: 1 2.

2 ( maximum of two deductions ). Subsidies will be calculated for all payroll deduction requests. Receipts must be forwarded to the HR Service Centre or your time administrator. All receipts must be legible, and show footwear are CSA approved. Credit Card or Interac slips will not be accepted. Authorized by: Title: To contact us call Toll Free 1-866-319-3900 or send us an E-Mail at HR-HELP or HR HELP Union Personal Information Protection (Privacy Legislation) The Personal Information and Electronic Documents Act, for federally regulated employers such as CPR, requires that the Company safeguards the privacy of, and maintains the confidentially of personal information collected, used and disclosed in the course of doing business and that access to information is provides only as stipulated within the Privacy of Information Policy #1804.

3 AUTHORIZATION FOR SUBSIDY ONLY, ON SAFETY. FOOTWEAR PURCHASED AND ALREADY PAID FOR BY EMPLOYEE. NAME: _____ EMPLOYEE NUMBER: _____. LOCATION: _____ DEPARTMENT: _____. _____ _____. (authorized signature) (title). Retail Outlets as of Aug 2005. Name Address City Province Marks Work Warehouse 110 Main Street N Moose Jaw SK. Gemmell's Shoes Ltd 473 Thatcher Drive E Moose Jaw SK. Marks Work Warehouse 2092 100th Street North Battleford SK. Marks Work Warehouse 800 15th Street E Prince Albert SK. Marks Work Warehouse 3915 Rochdale Blvd Regina SK. Marks Work Warehouse 635 University Park Drive Regina SK. Marks Work Warehouse 201 1st Avenue S Saskatoon SK. Marks Work Warehouse 300 Confederation Drive Saskatoon SK.

4 Marks Work Warehouse 101, 1715 Preston Avenue N Saskatoon SK. Marks Work Warehouse 1 Springs Drive Swift Current SK. Marks Work Warehouse 1240 Sims Ave Weyburn SK. Marks Work Warehouse 220A Broadway Street E Yorkton SK. Marks Work Warehouse 400 King Street Estevan SK. Marks Work Warehouse 1632 14th Avenue NW Calgary AB. Marks Work Warehouse 4889 130th Ave SE Calgary AB. Marks Work Warehouse 3800 Memorial Drive NE Calgary AB. Marks Work Warehouse 130 Country Village Road NE Calgary AB. Marks Work Warehouse 1035, 64th AVE SE Calgary AB. Marks Work Warehouse 3630 Brentwood Road NW Calgary AB. Marks Work Warehouse 109, 1135 64th Ave SE Calgary AB. Marks Work Warehouse 6800 48th Avenue Camrose AB.

5 Marks Work Warehouse 312, 5th Avenue W Cochrane AB. Marks Work Warehouse 5114 50th Avenue Cold Lake AB. Marks Work Warehouse 4341 50th Street Drayton Valley AB. Marks Work Warehouse 555 Highway 10 East Drumheller AB. Marks Work Warehouse 9122 51st Avenue Edmonton AB. Marks Work Warehouse 9915 178th Street Edmonton AB. Marks Work Warehouse 4278 137th Avenue Edmonton AB. Marks Work Warehouse 12222 137th Avenue Edmonton AB. Marks Work Warehouse 2010 101st Street Edmonton AB. Marks Work Warehouse 8770 170th Street Edmonton AB. Marks Work Warehouse 120 Mayfield Common NW Edmonton AB. Marks Work Warehouse 3803 Calgary Trail S Edmonton AB. Marks Work Warehouse 11426 104th Avenue NW Edmonton AB.

6 Marks Work Warehouse 204 50th Street Edson AB. Marks Work Warehouse 19 Reidel Street Fort McMurray AB. Marks Work Warehouse 9550 86th Avenue Fort Saskatchewan AB. Marks Work Warehouse 10350 108A Street Grande Prairie AB. Marks Work Warehouse 11801 100th Street Grande Prairie AB. Marks Work Warehouse 9806 100th Avenue High Level AB. Marks Work Warehouse 173 Pembina Avenue Hinton AB. Marks Work Warehouse 5124 Highway 2A Lacombe AB. Marks Work Warehouse 5309 Discovery Way Leduc AB. Marks Work Warehouse 1240 2A Avenue N Lethbridge AB. Marks Work Warehouse 10, 3728 Mayor Magrath Drive S Lethbridge AB. Marks Work Warehouse 4213 70th Avenue Lloydminster AB. Marks Work Warehouse 4, 4402 52nd Avenue Lloydminster AB.

7 Marks Work Warehouse 1, 1940 Strachan Road Medicine Hat AB. Marks Work Warehouse 3292 Dunmore Road SE Medicine Hat AB. Marks Work Warehouse 201 Southridge Drive Okotoks AB. Marks Work Warehouse 16B, 4513 52nd Avenue Olds AB. Marks Work Warehouse 7725 100th Ave Peace River AB. Marks Work Warehouse 6320 50th Avenue Red Deer AB. Marks Work Warehouse 2004 50th Avenue Red Deer AB. Marks Work Warehouse 4747 67th Street Red Deer AB. Marks Work Warehouse 4747 45th Street Rocky Mountain House AB. Marks Work Warehouse 342, 390 Baseline Road Sherwood Park AB. Marks Work Warehouse 100 Main Street Slave Lake AB. Marks Work Warehouse 96 Campsite Road Spruce Grove AB. Marks Work Warehouse 445 St.

8 Albert Road St. Albert AB. Marks Work Warehouse 4448 50th Avenue St. Paul AB. Marks Work Warehouse 109, 900 Pine Road Strathmore AB. Marks Work Warehouse 5212 48th Avenue Taber AB. Marks Work Warehouse 1009 14th Avenue Wainwright AB. Marks Work Warehouse 4721 51st Street Whitecourt AB. Marks Work Warehouse 2545 Mccallum Road Abbotsford BC. Marks Work Warehouse 26310 Fraser Highway Aldergrove BC. Marks Work Warehouse 9855 Austin Road Burnaby BC. Marks Work Warehouse 226, 4567 Lougheed Highway Burnaby BC. Marks Work Warehouse 104, 1334 Island Highway Campbell River BC. Marks Work Warehouse 1502 Columbia Avenue Castlegar BC. Marks Work Warehouse 45737 Luckakuck Way Chilliwack BC.

9 Marks Work Warehouse 15 King Edward Street Coquitlam BC. Marks Work Warehouse 3267 Cliffe Avenue Courtenay BC. Marks Work Warehouse 2100 Willowbrook Drive Cranbrook BC. Marks Work Warehouse 1000 Northwest Blvd Creston BC. Marks Work Warehouse 11000 8th Street Dawson Creek BC. Marks Work Warehouse 5259 Ladner Trunk Road Delta BC. Marks Work Warehouse 250 Trunk Road Duncan BC. Marks Work Warehouse 632 2nd Avenue Fernie BC. Valley Family Footwear 9600 93rd Avenue Fort St John BC. Marks Work Warehouse 101,1100 Sunshine Coast Hwy Gibsons BC. Marks Work Warehouse 150, 700 Tranquille Road Kamloops BC. Marks Work Warehouse 1395 Hillside Drive Kamloops BC. Marks Work Warehouse 500, 1500 Banks Road Kelowna BC.

10 Marks Work Warehouse 19892 Willowbrook Drive Langley BC. Marks Work Warehouse 20211 56th Avenue Langley BC. Marks Work Warehouse 22722 Lougheed Hwy Maple Ridge BC. Marks Work Warehouse 2761 Forksdale Avenue Merritt BC. Marks Work Warehouse 6631 Island Highway North Nanaimo BC. Marks Work Warehouse 6535 Metral Drive Nanaimo BC. Marks Work Warehouse 1150 Lakeside Drive Nelson BC. Marks Work Warehouse 1074 Marine Drive North Vancouver BC. Marks Work Warehouse 1074 Marine Drive North Vancouver BC. Marks Work Warehouse 2607 Skaha Lake Road Penticton BC. Marks Work Warehouse 3550 Johnston Road Port Alberni BC. Marks Work Warehouse 985 Nicola Avenue Port Coquitlam BC.