Retainer RFQ Part 'C' Forms

REQUEST FOR QUOTATION DOCUMENT

TO PROVIDE

CONSTRUCTION ADMINISTRATION

RETAINERSERVICES

PART C – FORMS AND NOTICES

Version 1.6

December 2016

RFQ Retainer for CA - Version 1.6, December 2016Assignment Number: INSERT

REQUEST FOR QUOTATION

Form 1

Offer Acceptance

The Ministry hereby accepts the Offer for this Assignment made by the Preferred Proponent______to provide the Services and Deliverables

(Name of the Service Provider)

specified in the RFQ annexed hereto and forming part hereof, in accordance with the RFQ, including the Terms and Conditions, and has caused its duly authorized official to execute this Acceptance on this ______day of ______, 201_.

The Preferred Proponent has been issued Agreement No. ______for the purposes of this Retainer.

HER MAJESTY THE QUEEN in right of the Province of Ontario, represented by the Minister of Transportation of the Province of Ontario

Authorized Ministry Representative / ______
(Title) / ______
(Telephone Number) / ______

REQUEST FOR QUOTATION

FORM 2 - ADDITIONAL INFORMATION

2.BRIEF HISTORY OF PROPONENT’S ORGANIZATION

2.1Legal Name of Business:

2.2 Owner(s); Partner(s); Corporate Officer(s)/Title:

2.3Business Address:Street, City, Province, Postal Code

Telephone NumberFacsimile Number

2.4Identification of Project Manager

2.5Position and Qualifications of each of the Staff Members Assigned in relation to this RFQ.

Only attach Resumes for positions requiring resumes in the Project Terms of Reference. All resumes must be accompanied by a consent form signed by the individual to the disclosure of the resume.

(NOTE: The Freedom of Information and Protection of Privacy Act Prohibits indirect collection of personal information without the consent of the individual concerned).

The response to this section shall also include the firm’s agreement to the following statement, Legal Name of Service Provider hereby declares to the Ministry that staff of sufficient numbers and qualifications will be provided as necessary at all times during this assignment.

2.6 Previous Experience of the PROPONENT with reference to the project description, deliverables and services

2.7SUMMARY IN NARRATIVE FORM OF THE PROPONENT'S UNDERSTANDING OF THE PROJECT TASKS AND DELIVERABLES AND SERVICES

Note to Proponents: The responses to Section 3 shall be combined into a single narrative written from an overview perspective and of no more than one (1) page in length. The narrative shall also include the proponent’s agreement to the statement “in the event of any conflicts between the requirements of the RFQ document and the content of the narrative response Section 3 then the content of the RFQ shall take precedence over the narrative.

REQUEST FOR QUOTATION

FORM 3(a) -CERTIFICATION - CONFLICT OF INTEREST

(Complete 3(a) OR 3(b))

Assignment Number: ______

I/we hereby certify that there is not / nor was there any actual or potential conflict of interest or unfair advantage in this Submission or performing the Work/Services required by this Agreement.

In submitting this Submission, our company has no knowledge of or the ability to avail ourselves of confidential information of the Crown (other than confidential information which may be been disclosed by the Ministry to the Service Providers in the normal course of the Request for Quotations) where the confidential information would be relevant to the Work/Services, their pricing or the Request for Quotations evaluation process.

Dated at______this ____ day of ______, 20____

An Authorized Signing Officer
(Key Contact/Alternate Contact approved in RAQS) / ______
(Title) / ______
(Firm’s Address) / ______
(Telephone Number) / ______

REQUEST FOR QUOTATION

FORM 3(b) - CERTIFICATION - CONFLICT OF INTEREST

(Complete 3(a) OR 3(b))

Assignment Number: ______

In submitting this Submission, the Proponent declares that the attached is a list of situations, each of which may be a conflict of interest, or appears as potentially a conflict of interest in our company submitting the Submission or performing the contractual obligations of the Service Provider under the Agreement. (Strike out Paragraph if not Applicable)

In submitting this Submission, our company has/has no (Strike out the inapplicable portion) knowledge of or the ability to avail ourselves of confidential information of the Crown (other than confidential information which may have been disclosed by the Ministry to the Proponents in the normal course of the Request for Quotations) where the confidential information would be relevant to the Work/Services, their pricing or the Request for Quotations evaluation process and where access to such additional information may prejudice the Crown or be an unfair advantage to the Service Provider.

(If declaring that the Proponent has access to additional information that may be confidential, other than confidential information that may be disclosed by the Ministry to the Service Providers in the normal course of the Request for Quotations, please attach an explanation describing the additional information and how you accessed it.)

With the exception of those situations and/or access to additional information disclosed on the list attached,I/we hereby certify that there is not nor was there any other actual or potential conflict of interest or unfair advantage in our submitting the Quotation or performing the Work/Services required by this Agreement.

I/We hereby acknowledge that the Ministry in its sole discretion shall have the right to determine whether or not the declared situations do constitute an actual or potential conflict of interest or whether access to additional confidential information does constitute an unfair advantage over other Proponents.

I/We acknowledge that in the event that the Ministry finds the situations to be a conflict of interest or access to the additional confidential information to be an unfair advantage that our Submission may be rejected.

Dated at ______this ____ day of ______, 20

An Authorized Signing Officer
(Key Contact/Alternate Contact approved in RAQS) / ______
(Title) / ______

REQUEST FOR QUOTATION

FORM 3(c) – LIST OF PEOPLE WHO PARTICIPATED IN PREPARATION OF THIS QUOTATION SUBMISSION

(Must be completed)

Assignment Number: ______

NAME: / ADDRESS: / TELEPHONE NUMBER: / CONTRIBUTION OR % OF WORK:

Dated at ______this ____ day of ______, 20

An Authorized Signing Officer
(Key Contact/Alternate Contact approved in RAQS) / ______
(Title) / ______
(Firm’s Address) / ______
(Telephone Number) / ______

REQUEST FOR QUOTATION

FORM 4 - OCCUPATIONAL HEALTH AND SAFETY STATUTORY DECLARATION

Assignment Number: ______

In submitting this Quotation Submission

I/we, on behalf of ______, certify the following:

(legal name of company)

(a)I/We have a health and safety policy and will maintain a program to implement such policy as required by clause 25(2)(j) the Occupational Health and Safety Act, R.S.O. 1990, c.O.1, as amended, (the "OHSA").

The requirements in (a) do not apply to employers with five (5) or less employees.

(b)With respect to the Services being offered in this Quotation, I/we and our proposed sub-contractor, acknowledge the responsibility to, and shall:

(i)fulfill all of the obligations under the OHSA and make reasonable efforts so that all work is carried out in accordance with the OHSA and its regulations.

(ii)make reasonable efforts so that adequate and competent supervision is provided as per the OHSA to protect the health and safety of workers; and

(iii)provide information and instruction to all employees to so that they are informed of the hazards inherent in the work and understand the procedures for minimizing the risk of injury or illness.

(c)I/We agree to take every precaution reasonable in the circumstances for the protection of worker health and safety, as required under the OHSA.

Dated at ______this ____ day of ______, 201_

An Authorized Signing Officer
(Key Contact/Alternate Contact approved in RAQS) / ______
(Title) / ______
(Telephone Number) / ______
(Firm’s Name) / ______
(Firm’s Address) / ______

REQUEST FOR QUOTATION

FORM 5 – RAQS DECLARATION FORM

Assignment Number: ______

In submitting this Quotation,

I/We, on behalf of ______(legal name of company),

hereby certify that our company is approved in RAQS for this Prime/RFQ Specialty and has verified that (check one of the following):

The Key Personnel approved in RAQS for this specialty are current and valid; or

The Key Personnel approved in RAQS for this Specialty are no longer current and valid, and the information for the Key Personnel replacement has been ‘Submitted For Approval’ in RAQS on ______(date).

Also hereby certify that our company has the prior registration of the Core Plan and for the Generic Category Plan for the Category where Prime/RFQ Specialty is located.

______Specialty

______Category

(Note: Prime Specialty applies to multi-specialty agreements, while RFQ specialty applies to single specialty situations).

Dated at ______this ____ day of ______, 201_

An Authorized Signing Officer
(Key Contact/Alternate Contact approved in RAQS) / ______
(Title) / ______
(Telephone Number) / ______
(Firm’s Name) / ______
(Firm’s Address) / ______

REQUEST FOR QUOTATION

FORM 6 –Option ‘A’ OR ‘B’– N/A

HOURLY BILLING RATES FEE SCHEDULE

Assignment Number: (insert number)

TO:Her Majesty the Queen in right of Ontario, represented by the Minister of Transportation for the Province of Ontario (the "Ministry).

FROM:(the "Proponent")

ADDRESS:

The Service Provider hereby tenders and offers to enter into a contract to provide the Services specified for this Assignment, for the hourly billing rates of:

Staff Positions / Hourly Billing Rates
Project Manager / $/hour
Road Construction Contract Administrator / $/hour
Road Construction Senior Inspector / $/hour
Road Construction Junior Inspector / $/hour
Electrical Inspector / $/hour
ATMS Inspector / $/hour
Office Person / $/hour
Checker / $/hour
Environmental Specialist / $/hour
Structural Specialist / $/hour
Equipment costs / $/hour
Daily expense rate / $/hour
Sample Delivery (Maximum 1 trip per day) / $ per Day per trip
Sample Delivery to Regional QA Laboratory (Maximum 1 trip per day) / $ per Day per trip
Sample Delivery to MTO MERO laboratory (Maximum 1 trip per day) / $ per Day per trip

and agrees that upon acceptance of this Offer by the Ministry, this Offer, the RFQ (Parts A, B, and C) to which this Offer is attached, and the successful Service Provider's Quotation Submission shall form a legally binding Agreement.

*Daily expense rate” means the daily cost to the Ministry per individual for living and travel expenses.

Option A – Weighted Hourly Billing Rate: Hourly cost to the Ministry per individual staff position inclusive of costs for: salary, benefits, overhead, payroll burden, profit, and Daily expense rate* and equipment costs. Site office costs are included in the Blended Rate.All Hourly Billing Rates are to include travel time.

Option B –Hourly Billing Rate: Hourly cost to the Ministry per individual staff position inclusive of costs for: salary, benefits, overhead, payroll burden and profit, excluding Daily expense rate* and equipment costs.All Hourly Billing Rates are to include travel time.

The Total Price should not include HST. Canada and Ontario have entered into a Comprehensive Integrated Tax Coordination Agreement whereby Ontario has agreed to pay harmonized sales tax (HST) on its purchases. For Deliverables provided on or after July 1, 2010, the supplier shall invoice and collect HST from the Ministry for the Deliverables in accordance with the provisions of the Excise Tax Act, R.S.C. 1985, c.E-15, as amended or replaced from time to time.

This Offer shall be irrevocable and open for acceptance for a period of ninety (90) days following the Quotation Submission Date.

Dated at ______this ____ day of ______, 201_

An Authorized Signing Officer:
(Key Contact/Alternate Contact approved in RAQS)
Title:
Telephone Number:
Firm’s Name:
Firm’s Address:

REQUEST FOR QUOTATION

FORM 6 – Option ‘C’ – N/A

HOURLY RATES AND EXPENSESFEE SCHEDULE

Assignment Number:(insert number)

TO:Her Majesty the Queen in right of Ontario, represented by the Minister of Transportation for the Province of Ontario (the "Ministry).

FROM:(the “Proponent”)

ADDRESS:

The Service Provider hereby tenders and offers to enter into a contract to provide the RETAINER Services specified, for this Assignment for the billing rates of:

Staff Position / Billing Rate
Project Manager / $/hour
Mobilization Rate / $/km
Road Construction Contract Administrator / $/hour
Daily Travel Rate / $/day
Daily Living Expense Rate / $/day
Mobilization Rate / $/km
Road Construction Senior Inspector / $/hour
Daily Travel Rate / $/day
Daily Living Expense Rate / $/day
Mobilization Rate / $/km
Road Construction Junior Inspector / $/hour
Daily Travel Rate / $/day
Daily Living Expense Rate / $/day
Mobilization Rate / $/km
Office Person / $/hour
Daily Travel Rate / $/day
Daily Living Expense Rate / $/day
Mobilization Rate / $/km
Checker / $/hour
Daily Travel Rate / $/day
Daily Living Expense Rate / $/day
Mobilization Rate / $/km
Sample Delivery (Maximum 1 trip per day) / $ per Day per trip
Sample Delivery to Regional QA Laboratory (Maximum 1 trip per day) / $ per Day per trip
Sample Delivery to MTO MERO laboratory (Maximum 1 trip per day) / $ per Day per trip

Northwestern Region to add or edit this form as needed.

and agrees that upon acceptance of this Offer by the Ministry, this Offer, the RFQ (Parts A, B, and C) to which this Offer is attached, and the successful Service Provider's Quotation Submission shall form a legally binding Agreement.

Hourly Billing Rate – the price in dollars per hour, which shall be full compensation for employee remuneration, payroll burden, Head Office and Job Overheads (excluding site office expenses) and profit.

Daily Travel Cost – the cost for travel while working on the contract site.

Daily Living Expense Rate – the cost living expenses while working on the contract site. This rate is applicable to working days which include overnight travel only.

Mobilization Rate is the cost per kilometre for travel from the principal or alternate mobilization point, whichever is closest, to and from the contract site.

Site Office and other requisite expenses not included in the above rates will be considered where necessary with proper justification and approval of the Ministry. The compensation for other expenses will be cost plus 5% mark-up.

This Offer shall be irrevocable and open for acceptance for a period of ninety (90) days following the Quotation Submission Date.

Dated at ______this ____ day of ______, 200_

An Authorized Signing Officer
(Key Contact/Alternate Contact approved in RAQS) / ______
(Title) / ______
(Telephone Number) / ______
(Firm’s Name) / ______
(Firm’s Address) / ______

REQUEST FOR QUOTATION

Form 7 - Check List of Mandatory Documents

Required for Quotation

Each of the following requirements is a part of this RFQ. Proponents shall indicate that they have included these required documents in their QuotationSubmission.

Document / Included
Transmittal Letter / Yes or No
RAQS Declaration Form / Yes or No
Occupational Health & Safety Statutory Declaration Form / Yes or No
Conflict of Interest Declaration Forms (Form 3A or 3B) / Yes or No
List of Proponent`s Staff Who Participated In Preparation of the RFQ Submission (Form 3C) / Yes or No
The format of the Proponent’s submission is complete and consistent with the RFQ requirements. / Yes or No
Fee Schedule (Form 6) / Yes or No

Dated at ______this ____ day of ______, 201_

An Authorized Signing Officer
(Key Contact/Alternate Contact approved in RAQS / ______
(Title) / ______
(Telephone Number) / ______
(Firm’s Name) / ______
(Firm’s Address) / ______

REQUEST FOR QUOTATION

FORM 8A – n/a

Work Item ORDER

Assignment No.: (insert number)

Order (Work Item) No.: (insert number)

ORDER

The Ministry hereby issues to the Service Provider a Work Item Order under the Agreement no. (insert number). The details of the Work Item are as follows:

This Work Item is for the Contract Administration of construction contract 200X-XXXX, located on Highway XXX, from X to X, for X km.

For Capital Construction Contract Documents, including any addenda, for all contracts, are to be purchased, using the Ministry’s RAQS/MERX System. Visit the RAQS/MERX siteto register. An annual subscription is required to purchase the contract documents in an electronic format or by an additional fee to obtain contract documents in hard copy format.

The successful Service Provider is responsible for obtaining and printing the Contracts Documents through the Ministry’s RAQS/MERX

Number of staff / Staff Positions / Testing / Equipment/Supplies and Office / Maximum Days / Maximum Hours
Project Manager(s) / Days / Hours
Road Construction Contract Administrator(s) / Days / Hours
Road Construction Senior Inspector(s) / Days / Hours
Road Construction Junior Inspector(s) / Days / Hours
Electrical Inspector / Days / Hours
ATMS Inspector / Days / Hours
Office Person
Checker(s)
Environmental Specialist
Structural Specialist
Testing / Equipment, Supplies and Office / Maximum Units
Field Testing – Compaction / Tests
Field Testing - Pavement Smoothness / Tests
Field Testing – Concrete Covermeter Survey / Tests
Field Testing – Concrete Half Cell Survey / Hours
Equipment,Supplies and Office / Months
Sample Delivery (Maximum 1 trip per day) / Note to user: MTO to provide estimate on # of trips.
Sample Delivery to Regional QA Laboratory (Maximum 1 trip per day) / Note to user: MTO to provide estimate on # of trips.
Sample Delivery to MTO MERO laboratory (Maximum 1 trip per day) / Note to user: MTO to provide estimate on # of trips.

Canada and Ontario have entered into a Comprehensive Integrated Tax Coordination Agreement whereby Ontario has agreed to pay harmonized sales tax (HST) on its purchases. For Deliverables provided on or after July 1, 2010, the supplier shall invoice and collect HST from the Ministry for the Deliverables in accordance with the provisions of the Excise Tax Act, R.S.C. 1985, c.E-15, as amended or replaced from time to time.

The Service Provider shall confirm its availability and shall provide the Ministry with a completed Form 8B, Work Item Quote Form within three (3) business days of receiving this Work Item Order.

Dated at ______this ____ day of ______, 201_

Authorized Ministry Representative / ______
(Title) / ______
(Telephone Number) / ______

REQUEST FOR QUOTATION

FORM 8B – n/a

Work Item QUOTE FOR OPTION ‘a’

wEIGHTED hOURLY BILLING RATES

Assignment No.: (insert number)

Work Item Order No.: (insert number)

TO:Her Majesty the Queen in right of Ontario, represented by the Minister of Transportation for the province of Ontario (the "Ministry).

FROM:(the "Service Provider")

ADDRESS:

The Service Provider hereby offers to complete Work Item Order No. (insert number), charging the Ministry only for the following (at the Ministry accepted staff billing rates offered in Fee Schedule Form 6A of the Quotation and the Work Item Order specific rates for the other Services listed in this Order Quote Form 8B):