RFP Retainer Version 6.0 May 2016 Appendices
RFP Retainer Appendices Index
Appendix 1Fee Schedule
Appendix 2AWork Item Order Form
Appendix 2BWork Item Quote Form
Appendix 3AClarification – No Conflict of Interest
Appendix 3BClarification – Conflict of Interest
Appendix 3CList of Service Provider Staff Who Participated in Preparation of the RFP Submission
Appendix 4AOccupational Health and Safety Statutory Declaration
Appendix 4BWork Item: OHS List of Designated Substances
Appendix 5 RAQS Declaration Form
Appendix 6Sample Assignments
Appendix 7Schedule Estimation Form
Appendix 8Competitive Cost Form
Appendix 9Check List of Mandatory Documents for RFP
Appendix 10other
APPENDIX 1: FEE SCHEDULE
Agreement #: insert number
TO:Her Majesty the Queen in right of Ontario as represented by the Ministry of Transportation (the “Ministry”).
FROM:
ADDRESS:
OFFER
The Respondent hereby acknowledges that it has examined all the Retainer RFP documents, including any addenda issued prior to the Proposal submission Deadline.The Service Provider hereby tenders and offers to enter into a contract to provide the RETAINER Services specified in the Legal Terms and Conditions and this Request for Proposals for the rates of:
FEE SCHEDULE
Rate / Unit / Activity / Key IndividualThe Service Provider agrees that upon acceptance of this Offer by the Ministry, this Offer, the RFP to which this Offer is attached, the successful Service Provider's Proposal and the Retainer Services Legal Terms and Conditions shall form a legally binding agreement.
The above totals do 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. 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 rates Proposed are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).
This Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Proposal Due Date.
I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:
______
Name of SignatoryDate
(Key Contact/Alternate Contact in RAQS)
______
Signature
______
Title Service Provider Firm Name
ACCEPTANCE
Assignment Number: ______
The Ministry hereby accepts the Offer of the Service Provider to provide the Services and Deliverables specified in the RFPannexed hereto and forming part hereof, in accordance with the RFP, including the Legal Terms and Conditions, and has caused its duly authorized official to execute this Acceptance this ______day of ______, ____.
HER MAJESTY THE QUEEN in right of the Province of Ontario, represented by the Minister of Transportation for the Province of Ontario
______
Signature of Regional/ Office Manager
______
Signature of Regional/ Branch Director
______
Signature of Assistant Deputy Minister
APPENDIX 2A: WORK ITEM ORDER FORM
Agreement #: insert number
ORDER
The Ministry hereby issues to the Service Provider an Order to complete Work Item no. (insert number). The details of the Work Item are as follows
The Service Provider shall immediately confirm its availability to the Ministry representative, and within two (2) business days of receiving this Work Item Order, shall provide the Ministry with an Assignment Proposal containing its Lump Sum Price for this assignment.
Signatures of Authorized Ministry Personnel:
Project Manager: ______
Signature:______
Date______
Functional Head: ______
Signature: ______
Date:______
RFP Retainer Version 6.0 May 2016 Appendices
APPENDIX 2B: WORK ITEM QUOTE FORM
Agreement #: insert number
OFFER
The successful Service Provider hereby offers to complete Work Item no. insert number, charging the Ministry only for the following (at the rates specified in the Fee Schedule Form included in Appendix 1 of the Proposal):
Time or Activity
The above totals do 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. 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.
I/We hereby certify that (legal name of bidding company), at the time of submitting this Proposal, have no conflict of interest in the performance of this assignment.
I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:
Name of Authorized Signing Officer:______
Signature: ______
Date: ______
MTO ACCEPTANCE:
Signatures of Authorized Ministry Personnel:
Regional Director/Manager:______
Signature: ______
Date: ______
APPENDIX 3A: CERTIFICATION - CONFLICT OF INTEREST
(Complete 3A or 3B - Do Not Complete Both)
Agreement #: insert number
I/we hereby certify that there is not nor was any actual or potential conflict of interest or unfair advantage in our submitting the Proposal or performing the Services required by the Agreement.
In submitting the Proposal, 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 Minister to the Service Providers in the normal course of the Request for Proposal) where the confidential information would be relevant to the Services, their pricing or the Request for Proposal evaluation process.
I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:
______
Name of SignatoryDate
(Key Contact/Alternate Contact in RAQS)
______
Signature
______
Title Service Provider Firm Name
APPENDIX 3B: CERTIFICATION - CONFLICT OF INTEREST
(Complete 3A or 3B - Do Not Complete Both)
Agreement #: insert number
In submitting our Proposal the Service Provider 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 Proposal or performing the contractual obligations of the Service Provider under the Agreement. (Strike out Paragraph if not Applicable)
In submitting the Proposal, 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 be been disclosed by the Minister to the Service Providers in the normal course of the Request for Proposal) where the confidential information would be relevant to the Services, their pricing or the Request for Proposal 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 Service Provider has access to additional information that may be confidential, other than confidential information which may be disclosed by the Minister to the Service Providers in the normal course of the Request for Proposal please attach an explanation describing the additional information and how you access to 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 Proposal or performing the Services required by the Agreement.
I/We hereby acknowledge that the Minister at his/her 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 Service Providers.
I/We acknowledge that in the event that the Minister finds the situations to be a conflict of interest or access to the additional confidential information to be an unfair advantage that our Request for Proposal may be rejected.
I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:
______
Name of SignatoryDate
(Key Contact/Alternate Contact in RAQS)
______
Signature
______
Title Service Provider Firm Name
APPENDIX 3C: LIST OF SERVICE PROVIDER STAFF WHO PARTICIPATED IN PREPARATION OF THE RFP SUBMISSION
Agreement #: insert number
Name / Business Address / BusinessTelephone
Number / Contribution Or % Of Work
APPENDIX 4A: OCCUPATIONAL HEALTH AND SAFETY STATUTORY DECLARATION
Agreement #: insert number
In submitting this Proposal, I/We, on behalf of (legal name of bidding company), certify the following:
(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 Proposal, I/we and our proposed Sub-Contractors, acknowledge the responsibility to, and shall:
(i)fulfill all of the obligations under the OHSA and make reasonable efforts to 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 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 ______20__
I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:
______
Name of SignatoryDate
(Key Contact/Alternate Contact in RAQS)
______
Signature
______
Title Service Provider Firm Name
RFP Retainer Version 6.0 May 2016 Appendices
APPENDIX 4B: Work Item: OHS List of Designated Substances
Agreement #: insert number
In accordance with the OHSA, a list of Designated Substances present in Ministry workplaces is provided in this section.
Ontario Regulation 490/09 lists the following eleven Designated Substances: Acrylonitrile, Arsenic, Asbestos, Benzene, Coke Oven emissions, Ethylene Oxide, Isocyanates, Lead, Mercury, Silica, Vinyl Chloride.
Of the above, MTO is aware that Silica, Lead, Asbestos and Arsenic were widely used in highway and bridge construction in the past and may be present within the project limits. In addition, there is a possibility that Benzene may be present in certain coating materials (such as coal tar epoxy) or as a result from a spill or from contamination from an adjacent property.
The remaining Designated Substances are not likely to be encountered in typical construction or maintenance activities of MTO infrastructure. Acrylonitrile and Vinyl Chloride are in Acrylonitrile Butadiene Styrene (ABS) and Polyvinyl Chloride (PVC) materials but are not considered Designated Substances once they have been polymerized and therefore do not need to be identified.
In accordance to the Occupational Health and Safety Act, R.S.O. 1990, c. 0.1, Proponents are advised of the presence of the Designated Substances presented in Table 4B.1 to which the Service Provider may be exposed when working at the specified locations or while the specified work activities are being undertaken.
Table 4B.1 Designated Substances In Ministry Workplaces
Designated Substance / Location or Work ActivitySilica / Handling sand or gravel. Handling road sweeping materials.
Silica will be present on all projects. Present throughout the working area including, but not limited to, asphalt, concrete, and granular materials.
Lead / Lead is assumed to be present in the epoxy coating on the reinforcing steel within the concrete deck and the work shall be performed as though lead is present.
Asbestos on Construction Projects and in Buildings and Repair Operations (O.Reg.278/05) / Patrol yard building materials (i.e., pipe insulation, ceiling/beam insulation, ceiling tiles, acoustic wallboards, floor tiles, ducts in bridges, etc.).
Located on the X Bridge in the Bearings identified as Transite Board. Material is non-friable. Reference report “Asbestos Analysis for the X Bridge” dated May 2013 and included elsewhere in the Contract Documents.
The conduit in the sidewalk of the bridge is assumed to contain asbestos and is assumed to be non-friable; however it shall be re-assessed when the material is exposed.
Asbestos may be found in some pavements, bridges, culverts, buildings, and electrical works:
- Asbestos may be found in conduits/ducts, bearings as well as in coatings found on structures and culverts.
- Asphalt Coated Asbestos Protected Corrugated Steel Culverts have been used in some projects.
- Asbestos may also be present as insulation and in numerous other building materials in existing buildings. Examples include: caulking, drywall joint compound, tiles, etc.
- Asbestos was used as a hot mix additive in some trials.
- Asbestos cement pipes may also have been used.
Mercury / Manometers, thermometers or other pressure or temperature sensing devices may contain mercury.Steel Structure coatings may contain small concentrations of mercury.
Mercury is not likely to be encountered as mercury vapour lamps have been replaced with high pressure sodium and LED for illumination. However mercury may be present in some electrical equipment and mercury vapour is present in fluorescent light tubes and other types of light fixtures in buildings.
Arsenic / Steel Structure coatings may contain small concentrations of arsenic.
May be found in pressure treated lumber (e.g. sign supports and some guiderail posts) and some steel structure coatings.
Benzene / Benzene may be present in certain coating materials such as coal tar epoxy.
Benzene may also be encountered in or adjacent to abandoned fuel storage facilities.
Vinyl Chloride, Coke Oven Emissions, Ethylene Oxide, Acrylonitrile and Isocyanates / Vinyl Chloride, Coke Oven Emissions, Ethylene Oxide, Acrylonitrile and Isocyanates are not normally present on MTO construction projects.
APPENDIX 5:RAQS DECLARATION FORM
In submitting this Expression of Interest/Request for Proposal
I/We, on behalf of ______, (Legal Name of company)
hereby certify that our company is approved in RAQS for this Prime/RFPSpecialty 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/approval of the Quality Core Plan and for the Generic Category Plan for the Category where Prime/RFP Specialty is located.
______ Specialty
______ Category
(Note: Prime Specialty applies to multi-specialty assignments, while RFPspecialty applies to single specialty situations).
Dated at ______this______day of ______, 20____
An Authorized Signing Officer(Key Contact/Alternate Contact listed in RAQS) / ______
(Title) / ______
(Telephone Number) / ______
(Firm’s Name) / ______
(Firm’s Address) / ______
(Signature) / ______
Note: In case of a Joint Venture, signatures of all partners are required.
APPENDIX 6: SAMPLE ASSIGNMENTS
APPENDIX 7: schedule estimation FORM
APPENDIX 8: COMPETITIVE COST FORM
APPENDIX 9: CHECK LIST OF MANDATORY DOCUMENTS FOR RFP
Agreement #: insert number
Each of the following requirements is a part of this RFP. Service Providers shall indicate that they have included these Required Documents in their Proposal.
Document / IncludedPhase I Submission
Transmittal Letter Signed by Key Contact/Alternate Contact in RAQS
RAQS Declaration Form (Appendix 5)
Service Provider’s Organizational Chart
Conflict of Interest Declaration (Appendix 3A or 3B & C)
Occupational Health & Safety Statutory Declaration Form (Appendix 4A)
Phase II Submission
Fee Schedule(s) (Appendix 1)
Schedule Estimation Form(s) (Appendix 7)
Competitive Cost Form(s) (Appendix 8)
I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:
______
Name of SignatoryDate
(Key Contact/Alternate Contact in RAQS)
______
Signature
______
Title Service Provider Firm Name
APPENDIX 10: