RFP Part C Forms and Tables Assignment Number

Request for Proposals

Total Project Management (TPM)

*Part C

Forms and Tables

Version 8.0 May 2015

Assignment Number: ______

Ministry of Transportation Ontario

* RFP Version 8.0 consists of 3 Parts. Part A contains General Terms and Conditions, which is to be RFP Part C – Forms and Tables Assignment Number Version 8.0 – May 2015 used in conjunction with Part B - Terms of Reference - Project Specific, and Part C – Forms and Tables.

TABLE OF CONTENTS

Sections and Schedules...... 1 Section 23: OHSA Statutory Declaration Form (Phase III Form)...... 2 Section 24: Certification - No Conflict Of Interest Forms (Phase I Forms)...... 3 Section 25: RAQS Declaration Form (Phase I Form)...... 6 Section 26: Certificate of Insurance Form (Phase III Form)...... 7

Price Forms (Phase II Form(s))...... 8 Section 27: Bid Price Form...... 8

Bid Price Summary Forms (Phase II Forms)...... 10 Form 27-1: Project Lump Sum Prices for Planning (By Category and Total) – N/A...... 10 Form 27-1-A: Price Breakdown for Project Management – N/A...... 12 Form 27-1-B: Price Breakdown For Environmental Planning – N/A...... 12 Form 27-1-C: Price Breakdowns For Highway Planning – N/A...... 12 Form 27-1-D: Price Breakdown For Highway Engineering – N/A...... 12 Form 27-1-E: Price Breakdown For Scope and Cost Reporting – N/A...... 12 Form 27-1-F: Price Breakdowns For Transportation (Systems) Planning – N/A...... 13 Form 27-1-G: Price Breakdown For Drainage And Hydrology Engineering – N/A...... 13 Form 27-1-H: Price Breakdown For Surveying – N/A...... 13 Form 27-1-I: Price Breakdown For Traffic Engineering – N/A...... 13 Form 27-2: Project Lump Sum Prices for Preliminary Design (By Category and Total) - N/A...... 14 Form 27-2-A: Price Breakdown for Project Management – N/A...... 16 Form 27-2-B: Price Breakdown For Advanced Traffic Management Systems – N/A...... 16 Form 27-2-C: Price Breakdown for Bridge Engineering – N/A...... 16 Form 27-2-D: Price Breakdown For Drainage And Hydrology Engineering – N/A...... 16 Form 27-2-E: Price Breakdown For Electrical Engineering – N/A...... 17 Form 27-2-F: Price Breakdown For Environmental– N/A...... 17 Form 27-2-G: Price Breakdown For Foundations Engineering – N/A...... 17 Form 27-2-H: Price Breakdown For Highway Engineering – N/A...... 18 Form 27-2-I: Price Breakdown For Scope and Cost Reporting – N/A...... 18 Form 27-2-J: Price Breakdown For Pavement Engineering – N/A...... 18 Form 27-2-K: Price Breakdown For Surveying – N/A...... 18 Form 27-2-L: Price Breakdown For Traffic Engineering – N/A...... 19 Form 27-2-M: Price Breakdown For Value Engineering – N/A...... 19 Form 27-3: Project Lump Sum Prices for Detail Design (By Category and Total) - N/A...... 20 Form 27-3-A: Price Breakdown for Project Management – N/A...... 22 Form 27-3-B: Price Breakdown For Advanced Traffic Management Systems – N/A...... 22 Form 27-3-C: Price Breakdown for Bridge Engineering – N/A...... 22 Form 27-3-D: Price Breakdown for Drainage and Hydrology Engineering – N/A...... 22 Form 27-3-E: Price Breakdown for Electrical Engineering – N/A...... 23 Form 27-3-F: Price Breakdown for Environmental – N/A...... 23 Form 27-3-G: Price Breakdown for Foundations Engineering – N/A...... 23 Form 27-3-H: Price Breakdown for Highway Engineering – N/A...... 24 Form 27-3-I: Price Breakdown for Scope and Cost Reporting – N/A...... 24 Form 27-3-J: Price Breakdown for Pavement Engineering – N/A...... 24 Form 27-3-K: Price Breakdown for Surveying – N/A...... 24 Form 27-3-L: Price Breakdown for Traffic Engineering – N/A...... 25 Form 27-3-M: Price Breakdown for Value Engineering – N/A...... 25 Form 27-3-N: Price Breakdown For Service Provider QC Plans Deliverables – N/A...... 25 Form 27-3-O: Price Breakdown For Constructability Review(s) – N/A...... 25 Form 27-3-P: Price Breakdown For Design Support and Liaison During Construction – N/A...... 26 Form 27-3-Q: Price Breakdown For Additional Biddable Work Items – N/A...... 26 RFP Part C – Forms and Tables Assignment Number Version 8.0 – May 2015

Form 27-4: Lump Sum Prices for Engineering Materials Testing - N/A...... 26 Form 27-4-A: Engineering Materials Field Testing Price Reference Table - N/A...... 27 Form 27-5: Budget Breakdown for Construction Contract Administration Services – N/A...... 28 Form 27-5-A: Construction Contract Administration Staff Pricing Table – N/A...... 29 Form 27-6: Total Project Prices Summary Table...... 30 Section 28: Form 6...... 31

Note: Please complete the follow-up price breakdown tables for each of the above-noted tables. RFP Part C – Forms and Tables Assignment Number Version 8.0 – May 2015

Sections and Schedules

Section 23: OHSA Statutory Declaration Section 24: Conflict of Interest Section 25: RAQS Declaration Form Section 26: Insurance Requirements Section 27: Financial Proposal Schedule 10 Section 28: Form 6 (Optional)

Note to User:

Phase I Forms: 1. Certification - No Conflict Of Interest Form (Section 24) 2. RAQS Declaration Form (Section 25)

Phase II Forms: 1. Price Form(s) 2. Bid Price Breakdown Forms

Phase III Forms: 1. Certificate of Insurance Form (Section 26) 2. OHSA Statutory Declaration Form (Section 23)

1 RFP Part C – Forms and Tables Assignment Number Version 8.0 – May 2015

Section 23: OHSA Statutory Declaration Form (Phase III Form)

In submitting this proposal, I/We, on behalf of , (Legal Name(s) of 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 above requirements 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) fulfil 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 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__

(Authorized Signing Officer for the Service Provider) (Authorized Signing Officer for the Service Provider)

(Title) (Title)

(Telephone Number) (Telephone Number)

(Authorized Signing Officer for the Service Provider)

(Title)

(Telephone Number)

Note: In case of a Joint Venture, signatures of all partners are required.

Section 24: Certification - No Conflict Of Interest Forms (Phase I Forms)

Form 24.1: Certification - No Conflict Of Interest (Phase I Form)

(Complete 24.1 or 24.2 - Do Not Complete Both)

I/We hereby certify that there is not nor was there 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 have 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.

______Name Signature (Key Contact/Alternate Contact listed in RAQS)

______Position Date

Form 24.2: Certification - Conflict Of Interest Form (Phase I Form)

(Complete 24.1 or 24.2 - Do Not Complete Both)

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 TPM Service Provider under the Agreement.

In submitting the Proposal, our Company has/has no (strike out the inapplicable) 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 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 TPM 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 have 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 Proposal may be rejected.

______Position Date

Form 24.2: Certification - Conflict Of Interest Form - Continued

______Position Date

Section 25: RAQS Declaration Form (Phase I 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/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/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 RFQ Specialty 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) ______

Section 26: Certificate of Insurance Form (Phase III Form)

To: Ministry of Transportation (hereinafter called the "Ministry"):

A: Comprehensive General Insurance

1. This is to certify that ______(Legal Name of Company)

(hereinafter called the "Service Provider") is insured by this insurer Policy No. (s) ______expiring ______, covering liability, as imposed by law or assumed by the Company under the terms of the above described Contract, for damages because of:

a) Bodily injury, sickness or disease, including death at any time resulting there from; and

b) Damage to or destruction of property of others caused by accident, including loss of use thereof;

subject to a limit of liability of not less than five million ($5,000,000) dollars, inclusive for any one occurrence.

2. As applying to the contract, the policy includes coverage for liability arising out of operations performed for the Service Provider by any Sub-Contractor.

3. The policy includes an additional insured, the Ministry, but only in respect of, and during, operations performed by or on behalf of the Service Provider and not in respect of any act or omission of the Ministry, or any of the Ministry's servants. In addition, the policy shall contain a Cross Liability Clause Endorsement.

4. The policy shall be an occurrence policy.

B: Professional Liability (Errors and Omissions) Insurance in an amount not less than $2,000,000 per claim in the aggregate.

In the event that the policy is changed or cancelled, the insurer agrees to give prior written notice to the Ministry in the manner set forth in the Policy Conditions.

Dated at ______this _____ day of ______20_

______(Signature of Insurer's Official) (Title)

Price Forms (Phase II Form(s))

Section 27: Bid Price Form

Lump Sum Price Proposal Form

GWP: ______

TO: Her Majesty the Queen in right of Ontario as represented by the Ministry of Transportation (“the Ministry”).

FROM: (the "Service Provider") ADDRESS:

TENDER

The Service Provider hereby tenders and offers to enter into a contract to provide the TPM Services specified in the Total Project Management Agreement and this Request for Proposals for the Lump Sum Price of $ and agrees that upon acceptance of this Tender by the Ministry, this Tender, the Total Project Management Agreement and the Request for Proposals response shall form a TPM legally binding agreement as described in this RFP document.

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 Tender shall be irrevocable and open for acceptance for a period of ninety (90) days following the Proposal Due Date as identified in Part B.

I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:

Signature of Authorized Signing Officer:

(Print Name, Title)

(Date)

Section 27: Bid Price Form – Continued

(Print Name, Title)

(Date)

(Print Name, Title)

(Date)

Bid Price Summary Forms (Phase II Forms)

Form 27-: Project Lump Sum Prices for Planning (By Category and Total) – N/A

PLANNING (P) ALL CURRENT NEXT FISCAL REMAINING TOTAL CATEGORY FISCAL YEAR YEAR YEARS ($) ($) ($) ($) Project Management Environmental Planning Highway Planning Highway Engineering Scope and Cost Report Transportation (Systems) Planning Drainage and Hydrology Surveying Traffic Add categories as required Add to scoring table too Engineering Materials Testing and Evaluation (Form 30-4) Service Provider QC Plans Deliverables (Supplementary Plan, Milestone Quality Reports) TOTAL PLANNING $ $ $ $

Notes: The above totals 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

Price Breakdown Forms

NOTE: The following price breakdown forms must be completed and provided with a financial proposal. Failure to provide the completed forms will result in disqualification of the proposal. Mark N/A in case the price for one or more Categories is not included in the proposal.

Form 27-1-C: Price Breakdown for Project Management – N/A

Project Management Item Fee Estimate $ Overall Project Management Project Meetings (Progress and milestone meetings) Total $

Form 27-1-D: Price Breakdown For Environmental Planning – N/A

Environmental Planning Item Fee Estimate $ Project Management Environmental Planning Study Total $

Form 27-1-E: Price Breakdowns For Highway Planning – N/A

Highway Planning Item Fee Estimate $ Project Management Highway Planning Study Total $

Form 27-1-F: Price Breakdown For Highway Engineering – N/A

Highway Engineering Item Fee Estimate $ Highway Engineering Project Management Design Total $

Form 27-1-E: Price Breakdown For Scope and Cost Reporting – N/A

Scope and Cost Reporting Item Fee Estimate $ Project Management Misc. Work Total $

Form 27-1-F: Price Breakdowns For Transportation (Systems) Planning – N/A

Transportation (Systems) Planning Item Fee Estimate $ Project Management Transportation Planning Study Total $

Form 27-1-G: Price Breakdown For Drainage And Hydrology Engineering – N/A

Drainage And Hydrology Engineering Item Fee Estimate $ Project Management (External Approvals) Design (Field Reviews, Data Collection, Reports) Total $

Form 27-1-H: Price Breakdown For Surveying – N/A

Surveying Item Fee Estimate $ Project Management Engineering Survey-Traffic Control Engineering Survey-Field Surveys Engineering Survey-Plan Preparation, DTM, H&V Sheets etc. Total $

Form 27-1-I: Price Breakdown For Traffic Engineering – N/A

Traffic Engineering Item Fee Estimate $ Project Management Design Activities Traffic Data Collection Traffic Study Total $

Form 27-2: Project Lump Sum Prices for Preliminary Design (By Category and Total) - N/A

PRELIMINARY DESIGN (PD)

ALL CURRENT NEXT FISCAL REMAINING TOTAL CATEGORY FISCAL YEAR YEAR YEARS ($) ($) ($) ($) Project Management Advanced Traffic Management Systems Bridge Engineering Drainage and Hydrology Engineering Electrical Engineering Environmental Foundations Engineering Highway Engineering Scope and Cost Report Pavement Engineering Surveying Traffic Engineering Value Engineering Engineering Materials Testing and Evaluation (Form 27-4) Service Provider QC Plans Deliverables (Supplementary Plan, Milestone Quality Reports) TOTAL PD: $ $ $ $

Notes: The above totals 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.

Form 27-2-I: Price Breakdown for Project Management – N/A

Project Management Item Fee Estimate $ Overall Project Management Project Meetings (Progress and milestone meetings) Total $

Form 27-2-J: Price Breakdown For Advanced Traffic Management Systems – N/A

Advanced Traffic Management Systems Item Fee Estimate $ ATMS Project Management Design Total $

Form 27-2-C: Price Breakdown for Bridge Engineering – N/A

Bridge Engineering Item Fee Estimate $ Project Management Design-Rehabilitation (field review, data collection, contract drawings, tender documents) Design-New Structures/Replacement (field review, data collection, contract drawings, tender documents) Design Retaining Walls Design OH Signs and Others Total $

Form 27-2-D: Price Breakdown For Drainage And Hydrology Engineering – N/A

Form 27-2-E: Price Breakdown For Electrical Engineering – N/A

Electrical Engineering Item Fee Estimate $ Project Management Design-Traffic Signals (Field Reviews, Data Collection, Contract Drawings, Approved Legal Drawings, Tender Documents) Design-Illumination (Field Reviews, Data Collection, Benefit Cost Analysis (High Mast vs. Conventional), Contract Drawings, Tender Documents Total $

Form 27-2-F: Price Breakdown For Environmental– N/A

Environmental Item Fee Estimate $ Project Management TESR DCR Screening Document PIC(s) Acoustics and Vibration Air Quality Assessment Archaeology/Heritage Contaminant / Waste Management Landscape Architecture Natural Sciences-Fisheries Natural Sciences-Others Socio-economics/ Agriculture Total $

Form 27-2-G: Price Breakdown For Foundations Engineering – N/A

Foundation Engineering Item Fee Estimate $ Project Management Site Access and/or specialized drilling methods or equipment Traffic Control Field Investigations Including drilling and Lab Testing Design (Report preparation) Total $

Form 27-2-H: Price Breakdown For Highway Engineering – N/A

Highway Engineering Item Fee Estimate $ Highway Engineering Project Management Design Erosion Sediment Control Design Total $

Form 27-2-I: Price Breakdown For Scope and Cost Reporting – N/A

Scope and Cost Reporting Item Fee Estimate $ Staff Position Misc. Work Total $

Form 27-2-J: Price Breakdown For Pavement Engineering – N/A

Pavement Engineering Item Fee Estimate $ Project Management Traffic Control Field Investigations (drilling, lab testing, etc) Design (Report preparation etc.) Total $

Form 27-2-K: Price Breakdown For Surveying – N/A

Surveying Item Fee Estimate $ Project Management Legal Surveys Engineering Survey-Traffic Control Engineering Survey-Field Surveys Engineering Survey-Plan Preparation, DTM, H&V Sheets etc. Total $

Form 27-2-L: Price Breakdown For Traffic Engineering – N/A

Form 27-2-M: Price Breakdown For Value Engineering – N/A

Value Engineering Item Fee Estimate $ Workshop #1 (also includes pre- and post-workshop activities) Workshop #2 (also includes pre- and post-workshop activities) Total $

Form 27-3: Project Lump Sum Prices for Detail Design (By Category and Total) - N/A

DETAIL DESIGN (DD)

ALL CURRENT NEXT FISCAL REMAINING TOTAL CATEGORY FISCAL YEAR YEAR YEARS ($) ($) ($) ($) Project Management Advanced Traffic Management Systems Bridge Engineering Drainage and Hydrology Engineering Electrical Engineering Environmental Foundations Engineering Highway Engineering Scope and Cost Report Pavement Engineering Surveying Traffic Engineering Value Engineering Service Provider QC Plans Deliverables (Supplementary Plan, Milestone Quality Reports) Constructability Review(s) Design Support and Liaison During Construction Additional Biddable Line Item Additional Biddable Line Item Engineering Materials Testing and Evaluation (Form 27-4) $ (Total is to be transferred to TOTAL PROJECT PRICE: $ $ $ the Proposal Form in Section 27-3)

Form 27-3-L: Price Breakdown for Project Management – N/A

Project Management Item Fee Estimate $ Overall Project Management Project Meetings (Progress and milestone meetings) Total $ Form 27-3-M: Price Breakdown For Advanced Traffic Management Systems – N/A

Advanced Traffic Management Systems Item Fee Estimate $ ATMS Project Management Design Total $

Form 27-3-N: Price Breakdown for Bridge Engineering – N/A

Bridge Engineering Item Fee Estimate $ Project Management Design-Rehabilitation (field review, data collection, contract drawings, tender documents) Design-New Structures/Replacements (field review, data collection, contract drawings, tender documents) Design Retaining Walls Design OH Signs and Others Total $

Form 27-3-D: Price Breakdown for Drainage and Hydrology Engineering – N/A

Form 27-3-E: Price Breakdown for Electrical Engineering – N/A

Electrical Engineering Item Fee Estimate $ Project Management Design-Traffic Signals (Field Reviews, Data Collection, Contract Drawings, Approved Legal Drawings, Tender Documents) Design-Illumination (Field Reviews, Data Collection, Benefit Cost Analysis (High Mast vs. Conventional), Contract Drawings, Tender Documents Total $

Form 27-3-F: Price Breakdown for Environmental – N/A

Environmental Item Fee Estimate $ Project Management TESR DCR Screening Document PIC(s) Acoustics and Vibration Air Quality Assessment Archaeology/Heritage Contaminant / Waste Management Landscape Architecture Natural Sciences-Fisheries Natural Sciences-Others Socio-economics/ Agriculture Total $

Form 27-3-G: Price Breakdown for Foundations Engineering – N/A

Foundation Engineering Item Fee Estimate $ Project Management Site Access and/or specialized drilling methods or equipment Traffic Control Field Investigations Including drilling and Lab Testing Design (Report preparation) Total $

Form 27-3-H: Price Breakdown for Highway Engineering – N/A

Highway Engineering Item Fee Estimate $ Highway Engineering Project Management Design Total $

Form 27-3-I: Price Breakdown for Scope and Cost Reporting – N/A

Scope and Cost Reporting Item Fee Estimate $ Staff Position Misc. Work Total $

Form 27-3-J: Price Breakdown for Pavement Engineering – N/A

Pavement Engineering Item Fee Estimate $ Project Management Traffic Control Field Investigations (drilling, lab testing, etc) Design (Report preparation etc.) Total $

Form 27-3-K: Price Breakdown for Surveying – N/A

Surveying Item Fee Estimate $ Project Management Legal Surveys Engineering Survey-Traffic Control Engineering Survey-Field Surveys Engineering Survey-Plan Preparation, DTM, H&V Sheets etc. Total $

Form 27-3-L: Price Breakdown for Traffic Engineering – N/A

Form 27-3-M: Price Breakdown for Value Engineering – N/A

Traffic Engineering Item Fee Estimate $ Workshop #1 (also includes pre- and post-workshop activities) Workshop #2 (also includes pre- and post-workshop activities) Total $

Form 27-3-N: Price Breakdown For Service Provider QC Plans Deliverables – N/A

Service Provider QC Plans Deliverables (Supplementary Plan, Milestone Quality Reports) Item Fee Estimate $ Supplementary Plan Milestone Quality Report 1 Milestone Quality Report 2 Milestone Quality Report 3 Milestone Quality Report 4 Total $

Form 27-3-O: Price Breakdown For Constructability Review(s) – N/A

Constructability Review(s) Item Fee Estimate $ Workshop Workshop Total $

Form 27-3-P: Price Breakdown For Design Support and Liaison During Construction – N/A

Design Support and Liaison During Construction Item Fee Estimate $

Misc. Work Total $

Form 27-3-Q: Price Breakdown For Additional Biddable Work Items – N/A

Additional Biddable Work Items Item Fee Estimate $

Misc. Work Total $

Form 27-4: Lump Sum Prices for Engineering Materials Testing - N/A

ENGINEERING MATERIALS TESTING

ALL CURRENT NEXT FISCAL REMAINING TOTAL CATEGORY FISCAL YEAR YEAR YEARS ($) ($) ($) ($) FIELD TESTING – N/A (Form 27-4-A) TOTAL PRICE: $ $ $ $

Form 27-4-A: Engineering Materials Field Testing Price Reference Table - N/A

No. of $/Test Tests Total $ Responsible Material Field Tests Party (A) (B) (A * B)

Earth Compaction

Granulars Compaction Review Mix Design Hot Mix Documentation Hot Mix Pavement Smoothness (Inertial Profiler) Review Mix Design Concrete Documentation Bridge Deck Waterproofing Thickness Half Cell Survey

Covermeter Survey Concrete Pavement Smoothness (Inertial Profiler) Dowell Pull Test

Water Well Testing / Well Investigation

Miscellaneous Traffic Paint Thickness

Glass Bead Distribution

TOTAL PRICE FOR FIELD TESTING $

Form 27-5: Budget Breakdown for Construction Contract Administration Services – N/A

CONSTRUCTION CONTRACT ADMINISTRATION SERVICES (CCA) –N/A (Not part of the pilot)

CURRENT NEXT FISCAL ALL TOTAL CATEGORY FISCAL YEAR YEAR REMAINING ($) ($) ($) YEARS ($)

1. STAFF PRICES $ $ $ $ (Form 27-5-A)

2. ENGINEERING MATERIAL FIELD TESTING COSTS $ $ $ $ (Form 27-4)

4. TOTAL PRICE (Total of two above categories to ------$ be transferred to Form 27.6)

The above totals should not include HST.

Form 27-5-A: Construction Contract Administration Staff Pricing Table – N/A

Total ($) for the Name of Staff Position Title Hourly Rate* ($) Position

Project Manager

Contract Administrator

Senior Inspector(s)

Junior Inspector(s)

Office Person / Junior Inspector

Total ($) for inclusion in Form 27-5 - Budget Breakdown For Construction Contract $ Administration Services

Notes:

 *Includes salary, benefits, equipment costs, overhead (office, computer, cell phones, etc.), payroll burden, and profit; excludes Daily Expense Rate.  * Regular duties included in amounts tendered in Form 27-5-A.  * If/when extra work becomes available the Hourly Rates provided in Form 27-5-A above will be used as threshold for negotiations. Any compensation for ‘extra work’ above and beyond the bid price is subject to Ministry approvals.  The Total Unit Price for Field Testing must be carried forward to the Budget Breakdown for Construction Contract Administration Services – Form 27-5-A.

The above totals should not include HST.

Form 27-6: Total Project Prices Summary Table

TOTAL PROJECT COST CURRENT NEXT FISCAL ALL TOTAL CATEGORY FISCAL YEAR YEAR REMAINING ($) ($) ($) YEARS ($) PLANNING: TOTAL LUMP SUM PRICE PRELIMINARY DESIGN: TOTAL LUMP SUM PRICE DETAIL DESIGN: TOTAL LUMP SUM PRICE CONSTRUCTION CONTRACT ADMINISTRATION: TOTAL LUMP SUM PRICE (Not part of the pilot) TOTAL PROJECT PRICE ------(Value for CPSS Evaluation)

Section 28: Form 6 (Optional – Phase I Form)

Note: This form is to be submitted only if there is a date indicated in Part B Section 11.3 of this RFP. Failure to provide a completed Form 6 by the due date, if indicated in Section 11.2 will result in the Service Provider’s submission disqualified.

The Proponent hereby acknowledges their intention to submit a Proposal for the Project noted below.

Project Title: ______

GWP/WO/Contract Number: ______

Assignment Number: ______

Ministry Project Manager: ______

An Authorized Signing Officer (name) (Key Contact/Alternate Contact listed in RAQS) ______

(Signature) ______

(Title) ______

(Telephone Number) ______

(Firm’s Name) ______

(Firm’s Address) ______