Retainer RFQ Part 'C' Forms

REQUEST FOR QUOTATION DOCUMENT

TO PROVIDE CONSTRUCTION CONTRACT ADMINISTRATION RETAINER SERVICES

PART C – FORMS AND NOTICES

Version 1.5

May 2016

RFQ Retainer for CA - Version 1.5, May 2016 Assignment 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) ______RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

FORM 2 - ADDITIONAL INFORMATION

2. BRIEF HISTORY OF SERVICE PROVIDER'S ORGANIZATION 2.1 Legal Name of Business: 2.2 OWNER(S); PARTNER(S); CORPORATE OFFICER(S)/TITLE: 2.3 BUSINESS ADDRESS: Street, City, Province, Postal Code Telephone Number Facsimile Number

2.4 IDENTIFICATION OF PROJECT MANAGER 2.5 POSITION 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 SERVICE PROVIDER WITH REFERENCE TO THE PROJECT DESCRIPTION, DELIVERABLES AND SERVICES 2.7 SUMMARY IN NARRATIVE FORM OF THE SERVICE PROVIDER'S UNDERSTANDING OF THE PROJECT TASKS AND DELIVERABLES AND SERVICES Note to Proponents: The responses to Sections 2.6 and 2.7 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 to Sections 2.6 and 2.7 then the content of the RFQ shall take precedence over the narrative. RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

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 listed in RAQS) ______

(Title) ______

(Firm’s Address) ______

FORM 3(b) - CERTIFICATION - CONFLICT OF INTEREST (Complete 3(a) OR 3(b))

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 (RAQS Key Contact/Alternate Contact) ______

(Title) ______RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

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

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

Dated at ______this ____ day of ______, 20

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

(Title) ______

(Firm’s Address) ______

FORM 4 - OCCUPATIONAL HEALTH AND SAFETY STATUTORY DECLARATION

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 listed in RAQS)

(Title) ______

(Telephone Number) ______

(Firm’s Name) ______

(Firm’s Address) ______RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

FORM 5 – RAQS DECLARATION FORM

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).

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

(Title) ______

FORM 6A – Option ‘A’ – 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 "Service Provider")

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 WBCMS (Note to user: only use for $ per user per construction contract Option c) 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.

Weighted 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.

*Daily expense rate” means the daily cost to the Ministry per individual for living and travel expenses. RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

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: RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

FORM 6B – Option ‘B’ – N/A BLENDED HOURLY BILLING RATES FEE SCHEDULE

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 Services specified for this Assignment, for the hourly billing rates of:

Staff Positions Blended Billing Rates Project Manager $ /hour Road Construction Contract $ /hour Administrator 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 WBCMS (Note to user: Only use $ per user per construction contract with option c)

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.

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. Site office costs are included in the Blended Rate. * All Hourly Billing Rates are to include travel time.

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

The Total Price should not include HST. RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

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.

An Authorized Signing Officer: (Key Contact/Alternate Contact listed in RAQS) Title: Telephone Number: Firm’s Name: Firm’s Address: RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

FORM 6C – Option ‘C’ – N/A HOURLY RATES AND EXPENSES FEE SCHEDULE

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, 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 WBCMS (Note to user: only use for Option c) $ /hour

Note to user: Northwestern Region to add or edit this form as needed. RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT 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.

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

(Title) ______

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 Quotation Submission.

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 Yes or No Submission (Form 3C)

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

Fee Schedule (Form 6) Yes or No

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

(Title) ______

FORM 8A – N/A WORK ITEM ORDER

Assignment 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 construction contract 200X-XXXX, located on Highway XXX, from X to X, for X km.

Note to user: Fill in the specific requirements of the Contract Administration Services that are required under this Work Item Order. These requirements shall include start date and duration noting start date is to include adequate mobilization time appropriate for the Ministry’s needs and the Service Providers resource allotment / scheduling, minimum ten (10) business days.

Note to user: Delete options in the paragraph below which does not apply.

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 site 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.

The successful Service Provider is responsible for obtaining and printing the Contracts Documents through the Ministry’s RAQS/MERX RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

Numbe Staff Positions / Testing / Maximum Maximum r of Equipment/Supplies and Office Days Hours staff Project Manager(s) Days Hours Road Construction Contract Administrator(s) Days Hours Hours Road Construction Senior Inspector(s) FORMTEXT Days Hours Road Construction Junior Inspector(s) FORMTEXT Days Hours Electrical Inspector FORMTEXT Days Hours ATMS Inspector FORMTEXT Days Office Person Checker(s) Environmental Specialist Structural Specialist Maximum Testing / Equipment, Supplies and Office 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

Note to user: Fill in the specific requirements of the Construction Contract Administration Services that are required under this Work Item Order.

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_ RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

(Title) ______

FORM 8B – N/A 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. RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

Weighted H o u r l y

Total B Daily (axb) + (cxd) for Staff Positions / i Number Expense staff, and Testing / Quantity l of Days Rate* See expenses and Equipment , l Note 1 (axb) for testing Supplies and (a) i (c) and equipment, Office n (d) supplies and g office. R a t e s

(b) Project Manager hrs $ Days $ /day $ /hour Road Construction hrs $ Days $ /day $ Contract /hour Administrator Road Construction hrs $ Days $ /day $ Senior /hour Inspector(s) Road Construction hrs $ Days $ /day $ Junior Inspector(s) /hour Electrical $ hrs Days $ /day $ Inspector(s) /hour ATMS Inspector(s) $ hrs Days $ /day $ /hour Office Person $ hrs Days $ /day $ /hour Checker(s) $ hrs Days $ /day $ /hour Environmental $ hrs Days $ /day $ Specialist /hour Structural $ hrs Days $ /day $ Specialist /hour Field Testing – $ /test $ Compaction Tests Field Testing - $ $ RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

Weighted H o u r l y

Total B Daily (axb) + (cxd) for Staff Positions / i Number Expense staff, and Testing / Quantity l of Days Rate* See expenses and Equipment , l Note 1 (axb) for testing Supplies and (a) i (c) and equipment, Office n (d) supplies and g office. R a t e s

(b) Pavement Tests /test Smoothness Field Testing – Concrete $ $ Covermeter Tests /test Survey Field Testing – $ Concrete Half Cell $ Tests /test Survey Equipment, $ Supplies and $ Months /month Office

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.

*Daily expense rate” means the daily cost to the Ministry per individual for living and travel expenses. RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

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.

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

(Title) ______

FORM 8B – N/A 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.

Quantity Blended Total Position (Hours/Days) Billing Rates (c = a x b) (a) (b) Project Manager $ $ Road Construction Contract $ $ Administrator Road Construction Senior Inspector $ $ Road Construction Junior Inspector $ $ Electrical Inspector $ $ ATMS Inspector $ $ Office Person $ $ Checker $ $ Environmental Specialist $ $ Structural Specialist $ $ Sampling Deliver $ $ Total $: $ RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

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).

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

(Title) ______(Telephone Number) ______(Firm’s Name) ______(Firm’s Address) ______RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

FORM 8B – N/A WORK ITEM QUOTE FOR OPTION ‘C’ HOURLY RATES AND EXPENSES FEE SCHEDULE

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 6C 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 8C. These Services are to be delivered in accordance with the Contract Administration Retainer Agreement.

Staff Position Quantity Billing Rate Total 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 $ RFQ Retainer for CA - Version 1.5, May 2016 Assignment Number: INSERT

Staff Position Quantity Billing Rate Total Daily Travel Rate $ /day $ Daily Living Expense Rate $ /day $ Mobilization Rate $ /km $ WBCMS (Note to user: only use for Option $ /hour $ c) Total $: $

Note to user: Northwestern Region to add or edit this form as needed.

(Title) ______

FORM 8C – N/A 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 – N/A 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) ______