Retainer RFQ Part 'C' Forms s1

REQUEST FOR QUOTATION DOCUMENT TO PROVIDE CONTRACT ADMINISTRATION SERVICES ON RETAINER

PART C – FORMS AND NOTICES

Version 1.4 September 2012 Assignment Number: INSERT RFQ Retainer for CA - Version 1.4, September 2012

FORM 1 CHECK LIST OF MANDATORY DOCUMENTS REQUIRED FOR QUOTATION

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

Document Included

Transmittal Letter Yes or No

RAQS Declaration Form (Form 2) Yes or No

Occupational Health & Safety Statutory Declaration Form (Form Yes or No 3)

Tax Compliance Declaration Form (Form 4) Yes or No

Conflict of Interest Declaration Forms (Form 5A or 5B) Yes or No

List of Service Provider Staff Who Participated In Preparation of Yes or No the RFQ Submission (Form 5C)

The format of the Proponent’s submission is complete and Yes or No consistent with the RFQ posting requirements.

Fee Schedule (Form 6) Yes or No

Dated at ______this ____ day of ______, 201_

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

(Title) ______

(Telephone Number) ______

(Firm’s Name) ______

(Firm’s Address) ______

2 Assignment Number: INSERT RFQ Retainer for CA - Version 1.4, September 2012

FORM 2 RAQS DECLARATION

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 The Key Personnel approved in RAQS for this Specialty are no longer current and valid, and the information for the Key Personnel replacement has been ‘Submitted For Approval’ in RAQS on ______(date).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 Speciality applies to multi-speciality agreements, while RFQ speciality applies to single speciality situations)

(Title) ______

FORM 3 OCCUPATIONAL HEALTH AND SAFETY STATUTORY DECLARATION

In submitting this Quotation, I/We, on behalf of ,______(legal name 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 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.

(Title) ______

FORM 4 TAX COMPLIANCE DECLARATION FORM

The Ontario Government expects all suppliers to meet their Ontario tax obligations on a timely basis. In this regard, proponents are advised that their Ontario tax obligations, if any, must be in good standing in order to be considered for a contract award. In order to be considered for a contract award, the proponent must submit the following tax compliance status statement and the following consent to disclosure:

Declaration

I/We hereby certify that ______at the (legal name of bidding company) time of submitting its quotation, is in full compliance with all applicable Ontario tax statutes, whether administered by the Ontario Ministry of Finance or by the Canada Revenue Agency, and that, in particular, all returns required to be filed have been filed and all taxes due and payable under those statutes have been paid or satisfactory arrangements for their payment have been made and maintained; or the Proponent will take all necessary steps prior to being considered for contract award in order to be in full compliance with all applicable Ontario tax statutes.

(Please check applicable box)

The Proponent  is /  is not a corporation subject to Ontario corporate tax under the Taxation Act, 2007 (Ontario).

(Please insert Proponent’s Business Number) ______

Consent to Disclosure

The Proponent consents to the Ministry of Transportation (“Requesting Ministry”) releasing the taxpayer information to the Ministry of Finance as necessary for the purpose of verifying the Proponent’s compliance with Ontario tax statutes.

The Proponent consents to the Ministry of Finance releasing taxpayer information to the Requesting Ministry as necessary for the purpose of verifying the Proponent’s compliance with Ontario tax statutes.

Dated at ______this ______day of ______, 20__

I have authority to bind the Proponent.

This Tax Declaration Form must be signed and the original included with the Quotation.

(Title) ______

FORM 5A CERTIFICATION - NO CONFLICT OF INTEREST

(Complete 5A or 5B - 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 Quotation or performing the Services required by the Agreement.

In submitting the Quotation, 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 Quotation) where the confidential information would be relevant to the Services, their pricing or the Request for Quotation evaluation process.

(Title) ______

FORM 5B CERTIFICATION - CONFLICT OF INTEREST (Complete 5A or 5B - Do Not Complete Both)

In submitting our Quotation 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 Quotation or performing the contractual obligations of the Service Provider under the Agreement. (Strike out Paragraph if not Applicable)

In submitting the Quotation, 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 Minister to the Service Providers in the normal course of the Request for Quotation) where the confidential information would be relevant to the Services, their pricing or the Request for Quotation 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 Quotation 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 Quotation 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 Quotation may be rejected.

(Title) ______

FORM 5C LIST OF SERVICE PROVIDER STAFF WHO PARTICIPATED IN PREPARATION OF THE RFQ SUBMISSION

Business Contribution Or Name Business Address Telephone % Of Work Number

(Title) ______

FORM 6A OPTION ‘A’ - HOURLY BILLING RATES FEE SCHEDULE

Retainer Agreement #: (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 tenders and offers to enter into a contract to provide the RETAINER Services specified in the Legal Agreement and this Request for Quotation 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 Office Person $ /hour Checker $ /hour and agrees that upon acceptance of this Offer by the Ministry, this Offer, the RFQ to which this Offer is attached, the successful Service Provider's Quotation and the Retainer Services Legal Agreement shall form a legally binding agreement.

Weighted Hourly Billing Rate - Hourly cost to the Ministry per individual staff position inclusive of following costs: salary, benefits, overhead, payroll burden and profit, excluding Daily expense rate* and equipment costs.

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

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.

An Authorized Signing Officer: (Key Contact/Alternate Contact listed in RAQS) Title:

Telephone Number:

Firm’s Name:

Firm’s Address:

FORM 6B OPTION ‘B’ – BLENDED HOURLY BILLING RATES FEE SCHEDULE

Retainer Agreement #: (insert number)

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

ADDRESS:

The Service Provider hereby tenders and offers to enter into a contract to provide the RETAINER Services specified in the Legal Agreement and this Request for Quotation for the hourly billing rates of:

Staff Positions Blended Hourly Billing Rates Project Manager $ /hour Road Construction Contract Administrator $ /hour Road Construction Senior Inspector $ /hour Road Construction Junior Inspector $ /hour Office Person $ /hour Checker $ /hour and agrees that upon acceptance of this Offer by the Ministry, this Offer, the RFQ to which this Offer is attached, the successful Service Provider's Quotation and the Retainer Services Legal Agreement shall form a legally binding agreement.

Blended Hourly Billing Rate – Hourly cost to the Ministry per individual staff position inclusive of following costs: salary, benefits, overhead, payroll burden, profit, and Daily expense rate* and equipment costs.

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.

An Authorized Signing Officer: (Key Contact/Alternate Contact listed in RAQS) Title:

Telephone Number:

Firm’s Name:

Firm’s Address:

FORM 7 RETAINER OFFER ACCEPTANCE

The Ministry hereby accepts the Retainer Agreement Offer made by the Service Provider ______to provide the Services and Deliverables specified in (Name of the Service Provider) 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 Service Provider 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) ______

FORM 8A WORK ITEM ORDER

Agreement No.: (insert number)

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

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 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 www.Raqs.Merx.com to 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.

For Regional Construction Contracts Documents any addenda, for all contracts, are to be purchased, using the Ministry’s Electronic Bidding System (EBS), from:

Contract Tendering Section Contract Management Office 2nd Floor, 301 St. Paul Street St. Catharines, Ontario L2R 7R4 Telephone: (905) 704-3025 Facsimile: (905) 704-2040

The successful Service Provider is responsible for obtaining and printing the Contracts Documents through either the Ministry’s RAQS/MERX System or Electronic Bidding System (EBS).

The Service Provider receiving this Work Item Order is responsible for obtaining and printing the Contracts Documents through the Electronic Bidding System (EBS).

Number Staff Positions / Testing / Equipment ,Supplies Maximum Maximum of staff and Office Days Hours Project Manager(s) Days Hours Road Construction Contract Administrator(s) Days Hours Road Construction Senior Inspector(s) Hours FORMTEXT Days Road Construction Junior Inspector(s) Hours FORMTEXT Days Office Person Checker(s) Testing / Equipment, Supplies and Office Maximum Units Field Testing - Compaction Tests Field Testing - Pavement Smoothness Tests Field Testing – Concrete Covermeter Survey FORMTEXT Tests Field Testing – Concrete Half Cell Survey Hours Equipment ,Supplies and Office Months

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.

(Title) ______

FORM 8B WORK ITEM QUOTE FOR OPTION ‘A’ WEIGHTED HOURLY BILLING RATES

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).

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):

This Work Item Order is for the Contract Administration Services of Contract 200X-XXXX, located on Highway XXX, from X to X, for X km, as described in Form 8A. These Services are to be delivered in accordance with the Contract Administration Retainer Agreement.

Staff Positions / Quantity Weighted Number of Daily Total Testing / Days Expense (axb) + (cxd) for Equipment , (a) (c) Rate* See staff, and Supplies and (b) Note 1 expenses and Office (axb) for testing (d) and equipment, supplies and office. Project Manager hrs $ /hour Days $ /day $

Road Construction hrs $ /hour Days $ /day $ Contract Administrator Road Construction hrs $ /hour Days $ /day $ Senior Inspector(s) Road Construction hrs $ /hour Days $ /day $ Junior Inspector(s) Office Person hrs $ /hour Days $ /day $

Checker(s) hrs $ /hour Days $ /day $

Field Testing – Tests $ /test $ Compaction

Field Testing - Tests $ /test $ Pavement Smoothness

Field Testing – Tests $ /test $ Concrete Covermeter Survey

Field Testing – Tests $ /test $ Concrete Half Cell Survey

Equipment,Supplies months $ /month $ and Office

$ Maximum Order Price ( Total of all Staff Positions / Testing / Equipment ,Supplies and Office Totals)

Weighted Hourly Billing Rate - Hourly cost to the Ministry per individual staff position inclusive of following costs: salary, benefits, overhead, payroll burden and profit, excluding Daily expense rate* and equipment costs.

I/We hereby certify that ______, have sufficient staff with valid Name of Company and applicable OACETT certification and designations as required for this Work Item Order.

I/We hereby certify that ______, at the time of submitting this Name of Company Quote have no conflict of interest in the performance of this Work Item Order.

(Title) ______

(Firm’s Address) ______16 Assignment Number: INSERT RFQ Retainer for CA - Version 1.4, September 2012

FORM 8B

WORK ITEM QUOTE FOR OPTION ‘B’ BLENDED HOURLY BILLING RATES

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

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 6B of the Quotation and the Work Item Order specific rates for the other Services listed in this Order Quote Form 8B):

This Work Item Order is for the Contract Administration Services of Contract 200X-XXXX, located on Highway XXX, from X to X, for X km, as described in Form 8A. These Services are to be delivered in accordance with the Contract Administration Retainer Agreement.

Position Blended Billing Rates Project Manager $ Road Construction Contract Administrator $ Road Construction Senior Inspector $ Road Construction Junior Inspector $ Office Person $ Checker $ Total $:

Blended Hourly Billing Rates – shall be the total amount payable for all Services, Deliverables, supplies and testing required to provide the Construction Contract Administration Services under this Retainer and shall be deemed to include full compensation for the Service Provider’s employees remuneration, payroll burden, Project Management costs, Head Office and Job Overheads, Daily expense rates*, and profit (excluding field office expenses, and any costs related to field equipment required for CA services).

I/We hereby certify that ______, have sufficient staff with valid Name of Company and applicable OACETT certification and designations as required for this Work Item Order.

I/We hereby certify that ______, at the time of submitting this Name of Company Quote have no conflict of interest in the performance of this Work Item Order.

(Title) ______

FORM 8C ACCEPTANCE OF WORK ITEM QUOTE

The Ministry hereby accepts the Work Item Quote made by the Service Provider ______to provide the Services and Deliverables specified in (Name of the Service Provider) 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_.

(Title) ______

FORM 8D NON-ACCEPTANCE OF WORK ITEM QUOTE

The Ministry hereby does not accept the Work Item Quote submitted by the Service Provider ______to provide the Services and Deliverables (Name of the Service Provider)

Specified in the RFQ annexed hereto, and has caused its duly authorized official to execute this Non-Acceptance on this ______day of ______, 201_.

(Title) ______