Program Overview
The OMA has created a centralized online directory (called eMarketplace) of service providers, intended to serve the physician community in Ontario for their medical practice product and service needs.
Offerings in general include products and services that are commonly used/needed by physicians in their medical practice. Through this channel, Ontario physicians are able to obtain Information Technology
(IT) support they need, within their community, from IT vendors listed in the eMarketplace who wish to provide timely service, quality products and excellent pricing to Ontario physicians.
Vendors who satisfy the following criteria are eligible to apply using this form:
1. Have an established business for a minimum of two (2) years at the time of application for the program;
2. Offer both onsite and remote services in one or several Ontario regions listed (Application Section 1);
3. Offer one or several services listed (Application Section 2)
4. Provide a minimum of three (3) satisfactory reference clients, from an established physician medical practice in Ontario and by using the vendor reference form included (Application Section 3)
Further information is included in this application regarding obligations and guidelines. In order to be considered for the eMarketplace, an applicant must complete this form in its entirety and submit it.
There are three (3) sections needed to be completed including three references. You will not be contacted if information is missing. If you have questions about completion of this form, please contact emarketplace@omaadvantages.ca
.
1. APPLICATION PROCESS a. Vendors who meet all of the eligibility criteria and wish to be included in the eMarketplace must complete and submit a Vendor Application Form in its entirety (includes a minimum of three (3) client references (Application Section 3). b. Upon receipt, OMA will review the application form for completeness and determine eligibility of the applicant. c. Upon meeting all the program requirements, approved Vendors will be notified and subsequently listed on the eMarketplace. d. Once a vendor has been approved to be listed on eMarketplace, OMA will include the vendor’s relevant information from Sections 1, 2 and 3 contained in this Application Form as soon as possible, usually within 10 business days from approval. e. Vendor applications are accepted on an ongoing basis via the OMA. OMA, without liability, cost or penalty, may in its sole discretion, at any time, alter, suspend, amend, supplement or cancel the program. f. All vendors will be charged an application fee of $150 (plus applicable tax), and then subsequently administration fee of $150 (plus applicable tax) due by June 1 annually. All fees must be paid within 30 days.
2. GUIDELINES AND OTHER IMPORTANT INFORMATION FOR VENDORS a. OMA, without liability, cost or penalty, may, in its sole discretion and at any time after the application submission, seek clarification from any applicant with respect to its application. Any written information received by OMA from an applicant in response to a request for clarification from OMA shall be considered an integral part of the vendor application process.

b. If a Vendor requests changes to the application, via the Change Request Form, subsequent to its approval by OMA, the OMA reserves the right to require the Vendor to restart the application process. c. OMA will not be held responsible for undeliverable notifications due to an incorrect email address or due to system or technical errors. d. Qualified Vendors assume sole responsibility for ensuring the accuracy of the IT services they are listed to provide on the eMarketplace. e. The OMA reserves the right to reject an application based on, but not limited to, information provided by references, on the types and range of services offered, on the regional services offered. All decisions regarding the Applicants eligibility for the online directory will be determined solely by OMA. f. OMA retains the right to disqualify or remove vendors at its sole discretion. g. OMA may verify any applicant’s claim or statement by whatever means OMA deems appropriate, including contacting references other than those offered by the applicant, and may reject any applicant statement or claim, if in the judgment of OMA the statement or claim is deemed to be unwarranted or lacking credibility h. There is no exclusivity for eMarketplace - physicians are not obligated to use vendors listed in the eMarketplace. i. There will not be a grant of rights to any vendors in the eMarketplace to use the OMA or OntarioMD logo and name. j. Once listed vendors have no right to assign their listing to another company. k. Once listed, vendors can remove services or regions or be removed entirely from the listing upon providing a completed Change Request Form to OMA via, emarketplace@omaadvantages.ca. This will be completed as soon as possible, usually within 10 business days of approval.
3. L IMITATION OF L IABILITY AND I NDEMNITIES a. Harm or loss suffered by a Physician, a Vendor as result of any breach by the other of them shall be compensated by way of a claim for direct damages actually proven only b. Incidental, indirect, exemplary, punitive, or consequential loss or damage (as well as damages such as lost business revenue, loss of profits, failure to realize expected profits or savings, or loss of data) c. OMA makes no representations or warranties, express or implied, concerning the services listed and/or rendered by vendors. d. OMA recommends that Physicians exercise due diligence in the selection of appropriate Vendors for their IT service and support needs, and in negotiating terms of engagement with Vendors. e. Indemnification by Vendors. Vendors shall indemnify, defend and hold harmless OMA from claims and liabilities of Physicians and losses, damages, causes of action or injuries arising from such Physicians’ claims, costs and expenses where the claim of such third party has resulted from any gross negligence or wilful misconduct on the part of Physicians from its or their failure to comply with all applicable governance processes. f. The eMarketplace does not, implicitly or expressly, guarantee provision of services to Physicians.
Physicians, at their sole discretion, may retain a listed Vendor’s services, according to Physicians’ own specific requirements. Physicians will be responsible for managing the selection, contractual arrangements, implementation and use of the services provided by the Vendor listed on the eMarketplace. The selected Vendor must provide services in accordance with the specifications herein and such requirements specified by client Physicians.
4. CONFIDENTIALITY AND DATA SHARING a. Vendors participating in the program understand and consent that information collected during delivery of the program will be collected, used, retained and disclosed to administer the Physician

eMarketplace program, and for no other purposes. Only persons and organizations authorized by OMA shall have access to and use this information.
Vendor Information
Contact Name: _________________________________________________________
(first name) (last name)
Contact email address: ___________________________________________________
Contact direct telephone number: __________________________________________
Company Name (to be listed): ______________________________________________
Company Phone number (to be listed): ______________________________________
Email of the company contact (to be listed): __________________________________
Physical Address (to be listed):_____________________________________________
Year Company was founded/date incorporated (to be listed):
___________________________________
Company profile - 150 character max (optional, to be listed):

1.
Geographic Region Vender Serves (to be listed)
Select the Geographic Region and area which your commodity/product or service will be available to physicians by clicking the checkboxes below:

Toronto

Etobicoke

North York

South West

Windsor

Chatham

Sarnia

Grand Bend

Goderich

Kincardine

Owen Sound

Wiarton

Ajax

Whitby
 Cobourg

Central East

Hastings

Havelock
 Peterborough

Millbrook

Bracebridge

Oshawa


Lindsay

Innisfill

Trenton
Central West
 Halton
 Oakville

Markham

Caledon
 Grand Valley
 Aurora

New Market

Georgina

Scarborough

Ottawa

Kingston
 Gananoque

Brookville

Huntsville

East York

Hamilton/Niagara/Waterloo

Niagara Falls

St. Catherine’s

Hamilton

Kitchener

Waterloo

Brantford

London

Simcoe

Guelph

Eastern

Bancroft

Petawawa
 Cornwall

Bellville

Orillia

 North Bay
 Sudbury

Elliot Lake

Sault Ste. Marie

Kenora
North
 Timmins
 Cochrane

Thunder Bay

Fort Frances
2.
Commodity/Product or Service Type Provided (to be listed)
Select Commodity/Product or Service types by clicking the checkboxes below:
General hardware and software support services
Infrastructure:

Workstation (PC, Mac, desktop and laptop)

Email support (local, hosted, cloud, hybrid)
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Internet including security ( firewall and
VPN)

Network performance monitoring and


 optimization
Telecom System management
IP telephony and VOIP Management
Server management and virtualization
Peripheral support:

Printer

Fax Server

Scanner

Card Reader
Software product support:

MAC OS X 10.0 through to 10.8

Microsoft Windows OS

Microsoft Office Software Suite: Word,
Excel, Access, PowerPoint, Project,
SharePoint, Publisher, Outlook

Mobile device support:

Smartphone (iPhone, Blackberry,
Android)

Tablets (IOS, Android, Windows)
3.
REFERENCE INFORMATION
Provide three (3) client references, from an established physician medical practice in Ontario. If requesting to be listed for more than one service it is suggested references relate to more than one service. For each client, please provide the following:

Customer – Name, Address

Contact Person – Name, Title, Telephone Number, Email Address

A brief description of the project including

Its deliverables/product/service;

Duration;

Estimated value;

Outcomes.

Include any details that would highlight your experience in the service areas to the ones being requested as part of the Physician eMarketplace.
REFERREE #1
Name of Medical Practice (e.g., First Street Family Health Group):
_________________________________________________________
Client Address: _________________________________________________________
Contact Name:
Contact Title:
_________________________________________________________
_________________________________________________________
Contact Telephone Number: _________________________________________________________
Contact Email Address: _________________________________________________________
Project Description (150 words max.):

REFERREE #2
Name of Medical Practice: _________________________________________________________
Client Address:
Contact Name:
_________________________________________________________
_________________________________________________________
Contact Title: _________________________________________________________
Contact Telephone Number: _________________________________________________________
Contact Email Address: _________________________________________________________
Project Description (150 words max.):
REFERREE #3
Name of Medical Practice:
Client Address:
Contact Name:
Contact Title:
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
Contact Telephone Number: _________________________________________________________
Contact Email Address: _________________________________________________________
Project Description (150 words max.):

DECLARATIONS AND CONSENT
I declare that I am a representative of ______________________ and that all the information I have provided in the application is accurate and true.
I hereby consent to OMA and/or its subsidiaries to collecting and using pertinent information as shown above and disclosing such collected information for the purpose of program administration, reporting and audit.
By signing and submitting this form I acknowledge that I have reviewed, am aware of the various criteria, guidelines and agree to the expectations outlined in the eMarketplace Terms & Conditions in order for my company to be a listed vendor on the eMarketplace.
Date: ___________________ Applicant's Signature: _________________________