UNIVERSITY OF LETHBRIDGE RFQu-2016-2608

APPENDIX A

REQUEST FOR QUALIFICATION STATEMENT FORM - RFQu-S2016-2608
  1. GENERAL

1.1.Project:University of Lethbridge Destination Project Lethbridge, Alberta

Provision of Consulting and Design Services for Physical Security Measures for the Destination Project’s Science and Academic Building

1.2.Request for Qualification Submission to:

Mr. Daryl Schacher, Manager,

Materials Management

University of Lethbridge

Parkway Service Complex Building

4401 University Drive

Lethbridge, AB., T1K 3M4

  1. CORPORATE INFORMATION

2.1.Name and Address of Applicant

Company Name:
Address:
Contact Name:
Telephone: / Fax:

2.2.Parent, Affiliates, Divisions, Subsidiaries:

2.3.Type of Company:

CorporationPartnershipIndividualOther

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UNIVERSITY OF LETHBRIDGE RFQu-2016-2608

2.4.Date of Establishment of Company:

Date:______

2.5.List of Company Officers, Principals, Partners and Date of Appointment:

Name:
Title: / Date of App:
Name:
Title: / Date of App:
Name:
Title: / Date of App:

2.6.Head Office Address (if different from above):

Company Name:
Address:
Contact Name:
Telephone: / Fax:

2.7.Key Personnel

2.7.1.List of key personnel who will be assigned to this contract. Include a staff commitment chart that shows the extent to which these resources are dedicated to the project. Attach resumes giving qualifications, experience, and references for similar projects. Include a Project Organization Chart for your personnel.

Name: / Title:
Name: / Title:
Name: / Title:
Name: / Title:
  1. INSURANCE INFORMATION

3.1.Insurance Coverage:

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UNIVERSITY OF LETHBRIDGE RFQu-2016-2608

  • Is your firm capable of providing Comprehensive Or Commercial General Liability Insurance and Automobile Liability Insurance; both against bodily injury, death and property damage, with limits of not less than $5,000,000.00 inclusive per occurrence for Commercial General Liability Insurance and $2,000,000 per occurrence for Automobile Liability insurance? Please include a proof of insurance letter with your response.

YesNo

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UNIVERSITY OF LETHBRIDGE RFQu-2016-2608

3.2.Insurance Company Information:

Company Name:
Address:
Contact Name & Title:
Telephone: / Fax:

3.3.Insurance History

Have you put in a property or liability claim to your insurer in the last Yes No

5 years? If Yes, provide details.

3.4.Legal History

Advise of any legal disputes, claims, lawsuits or other proceedings, including arbitration or mediation, to resolve disputes that the firm is currently involved in or are scheduled for litigation. Identify potential liability for each dispute

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UNIVERSITY OF LETHBRIDGE RFQu-2016-2608

APPENDIX B

DISCLOSURE AND COMPLIANCE STATEMENT - RFQu-S2016-2608

FULL DISCLOSURE

As per the requirements identified in Section 7.2 of the RFQu document, please provide details concerning the issue of disclosure by your firm.

COMPLIANCE WITH RFQu TERMS AND CONDITIONS

As per the requirements identified in Section 7.2 of the Request for Qualification document, please indicate to accept and comply with the RFQu terms and conditions.

INSURANCE COMPLIANCE

The Proponent agrees that if successful that all necessary Insurance requirements will be met as per Section 7.14

□Agreedor□if not, please identify your alternative solution to our request.

WORKERS COMPENSATION COMPLIANCE

Worker’s Compensation Board Clearance Letter: □ No□ Yes (Please provide copy)

The Applicant agrees to comply with all local, provincial and federal statutory requirements and all regulations pertaining thereto at all times.

The Applicant, by its execution hereof, hereby agrees and accepts each of the foregoing terms and conditions.

DATED, this ___ day of ______, 20___.

Applicant’s Signature
Applicant’s Name (Print)

.APPENDIX C

SUPPLEMENTAL RFQu RESOURCES

The following supplemental resources can be found at Respondents are encouraged to review the documents below to gain a more complete understanding of the task at hand.

  • University Campus Master Plan
  • Stormwater Master Drainage Plan
  • Slab & Continuous Drop Partial Plan
  • Whole Building - Schematic Design
  • Interior/Exterior Renderings
  • Schematic Design Report
  • Pre-Design Phase – Final Report
  • Floorplans

APPENDIX D

RECEIPT CONFIRMATION FORM

Please complete this form and e-mail or fax immediately to:

Daryl Schacher

Manager, Materials Management

The University of Lethbridge

4401 University Drive

Lethbridge, AB T1K 3M4

e-mail:

Fax: (403) 329-2080

Failure to return this form shall result in no further communication regarding this Request for Proposal.

COMPANY NAME:
ADDRESS:
CONTACT PERSON:
CONTACT e-mail:
CONTACT TELEPHONE: / CONTACT FAX:
I have received a copy of the above noted RFQu-S2016-2608; Provision of Consulting and Design Services for Physical Security Measures for the Destination Project Science and Academic Building.

A total of ______pages were received.

Yes, I will be responding to this request. Therefore, I authorize The University of Lethbridge to send further correspondence that it deems to be of an urgent nature by the following method:

Courier Collect (specify Courier and Acct #______)

Facsimile

Mail

E-Mail

No, I will not be responding.

I understand that if I do not return this form our company will not receive any further notices with regard to this Proposal.

SIGNATURE: ______

TITLE: ______DATE: ______

ALL SUBMISSIONS MUST BE RECEIVED IN OUR OFFICE BY 3:00 P.M. (MST),

March 3, 2016

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