RFQ Goods and Services s2

SCHEDULE B - QUOTATION

RFQ Title: Water Meter Maintenance Services

RFQ No: 1220-040-2015-053

CONTRACTOR

Legal Name:

Address:

Phone:

Email:

CITY OF SURREY

City Representative: Richard D. Oppelt, Purchasing Manager

Address: Surrey City Hall Finance & Technology Department – Purchasing Section Reception Counter – 5th Floor West 13450 - 104 Avenue, Surrey, B.C., Canada, V3T 1V8

E-mail for PDF Files: [email protected]

1. If this Quotation is accepted by the City, a contract will be created as described in: (a) the Agreement; (b) the RFQ; and (c) other terms, if any, that are agreed to by the parties in writing.

2. Capitalized terms used and not defined in this Quotation will have the meanings given to them in the Agreement and RFQ. Except as specifically modified by this Quotation, all terms, conditions, representations, warranties and covenants as set out in the Agreement and RFQ will remain in full force and effect.

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 56 of 86 3. I/We have reviewed the RFQ Attachment 1 – Draft Agreement. If requested by the City, I/we would be prepared to enter into that Agreement, amended by the following departures (list, if any):

Section Requested Departure(s) / Alternative(s)

4. The City requires that the successful Contractor have the following in place before providing the Goods and Services:

(a) Workers’ Compensation Board coverage in good standing and further, if an “Owner Operator” is involved, personal operator protection (P.O.P.) will be provided, Workers' Compensation Registration Number ______; (b) Prime Contractor qualified coordinator is Name: ______and Contact Number: ______; (c) Insurance coverage for the amounts required in the proposed Agreement as a minimum, naming the City as additional insured and generally in compliance with the City’s sample insurance certificate form available on the City’s Website Standard Certificate of Insurance; (d) City of Surrey or Intermunicipal Business License: Number ______; (e) If the Contractor’s Goods and Services are subject to GST, the Contractor’s GST Number is ______; and (f) If the Contractor is a company, the company name indicated above is registered with the Registrar of Companies in the Province of British Columbia, Canada, Incorporation Number ______.

As of the date of this Quotation, we advise that we have the ability to meet all of the above requirements except as follows (list, if any):

Requested Departure(s) / Alternative(s)

5. The Contractor acknowledges that the departures it has requested in Sections 3 and 4 of this Quotation will not form part of the Agreement unless and until the City agrees to them in writing by initialing or otherwise specifically consenting in writing to be bound by any of them.

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 57 of 86 SECTION B-1

Changes and Additions to Specifications:

6. In addition to the warranties provided in the Agreement, this Quotation includes the following warranties:

7. I/We have reviewed the RFQ Attachment 1, Schedule A – Specifications of Goods and Scope of Services, to Attachment 1. If requested by the City, I/we would be prepared to meet those requirements, amended by the following departures and additions (list, if any):

Requested Departure(s) / Alternative(s) / Addition(s)

SECTION B-2

Fees and Payments

8. The Contractor offers to supply to the City of Surrey the Goods and Services for the prices plus applicable taxes as follows:

F.O.B. Payment Terms: Ship Via: Destination A cash discount of ____% will be allowed if invoices are paid Freight within ___ days, or the ___ day of the month following, or net Prepaid 30 days, on a best effort basis.

PART A: PROGRAM WORK 1. Locate and Expose Buried Meter Box

Quantity Price 1 Price 2 20 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 58 of 86 2. Removals and Re-installation of Asphalt and Concrete Surfaces

Type Quantity Price 1 Price 2 Asphalt (Sq. Meter) 10 $ $ Concrete (Sq. meter) 10 $ $

3. Hazards and Debris Removal Type Quantity Price 1 Price 2

Debris (wood & dirt) 10 $ $ Needles & Syringes 10 $ $

4. Replace Wiring Type Quantity Price 1 Price 2

Replace damaged wiring 25 $ $

5. Lid Replacement Chamber Size Quantity Price 1 Price 2

300x500 15 $ $ 425x750 10 $ $ 600x900 10 $ $

6. Mount Pitpad Type Chamber Size Quantity Price 1 Price 2

300x500 35 $ $ Mount into Existing lid 425x750 35 $ $ 600x900 10 $ $

300x500 35 $ $ Mount with new lid 425x750 35 $ $ 600x900 10 $ $ 7. Replace Remote Receptacle

Type Manufacturer Quantity Price 1 Price 2 Sensus 25 $ $ Wall Mounted ABB 25 $ $ Neptune 25 $ $

Sensus 25 $ $ Pit Pad ABB 25 $ $ Neptune 25 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 59 of 86 8. Relocate Remote Receptacle

9. Pre-Cast Concrete Meter Box Type Size Quantity Price 1 Price 2

150mm 10 $ $ 300mmx500mm 300mm 4 $ $

150mm 10 $ $ 425mmx750mm 200mm 5 $ $ 250mm 5 $ $

150mm 4 $ $ 600mmx900mm 200mm 3 $ $ 250mm 2 $ $

9 a. HDPE Composite Meter Box Type Size Quantity Price 1 Price 2

Raven Products 300mm 10 $ $ 280mm x457mm 300mm EXT 4 $ $ 457mm 5 $ $

300mm 10 $ $ 430mm x760mm 300mm EXT 5 $ $ 457mm 5 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 60 of 86 10. Replace Register Type Meter Size (mm) Quantity Price 1 Price 2 16x19 50 $ $ 19 30 $ $ Sensus SRII Meter 25 10 $ $ 38 10 $ $ 50 10 $ $

16x19 40 $ $ 19 30 $ $ Neptune T-10 Meter 25 10 $ $ 38 10 $ $ 50 10 $ $

16x19 40 $ $ 19 30 $ $ Elster C-700 Meter 25 10 $ $ 38 10 $ $ 50 10 $ $ Sensus Omni Meter 50 10 $ $ 75 5 $ $ Neptune TT, HPT 100 5 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 61 of 86 11. Replace Water Meter

Type Meter Size (mm) Quantity Price 1 Price 2 16x19 6 $ $ 19 5 $ $ Sensus SRII Meter 25 4 $ $ 38 3 $ $ 50 2 $ $

16x19 6 $ $ 19 5 $ $ Neptune T-10 Meter 25 4 $ $ 38 3 $ $ 50 2 $ $

16x19 6 $ $ 19 5 $ $ Elster C-700 Meter 25 4 $ $ 38 3 $ $ 50 2 $ $ Sensus iPERL 19 150 $ $ SensusOmni Meter 50 50 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 62 of 86 12. Replace Meter Setter

Type Height (mm) Quantity Price 1 Price 2 Ford 70 Series 178 5 $ $ 228 5 $ $ 305 20 $ $ 16mm x19mm 381 1 $ $ 458 1 $ $ 533 1 $ $ 610 1 $ $

203 1 $ $ 305 10 $ $ 381 1 $ $ 19mm 457 1 $ $ 533 1 $ $ 610 1 $ $

254 1 $ $ 305 5 $ $ 381 1 $ $ 25mm 458 1 $ $ 534 1 $ $ 610 1 $ $

305 1 $ $ 381 1 $ $ 457 1 $ $ 38mm 533 1 $ $ 610 1 $ $ 686 1 $ $

305 1 $ $ 381 1 $ $ 50mm 457 1 $ $ 533 1 $ $ 610 1 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 63 of 86 12a.

Type Height (mm) Quantity Price 1 Price 2 Other Types Specify: (specify height in the appropriate box) 16mm x19mm 686mm to 1016mm 5 $ $ 19mm 686mm to 1016mm 5 $ $ 25mm 686mm to 1016mm 1 $ $ 38mm 686mm to 1016mm 1 $ $ 50mm 686mm to 1016mm 1 $ $

13. Replacement of Water Meter System

Type Meter Size (mm) Quantity Price 1 Price 2 0m – 1.5m (depth) 16x19 1 $ $ 19 1 $ $ Sensus SRII Meter 25 1 $ $ 38 1 $ $ 50 1 $ $

16x19 1 $ $ 19 1 $ $ Neptune T-10 Meter 25 1 $ $ 38 1 $ $ 50 1 $ $

16x19 1 $ $ 19 1 $ $ Elster C-700 Meter 25 1 $ $ 38 1 $ $ 50 1 $ $ Sensus Omni Meter 50 1 $ $ Sensus iPERL Meter 19 10 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 64 of 86 13a. 1.6 m – 2.0 m (depth) Type Meter Size (mm) Quantity Price 1 Price 2 16x19 1 $ $ 19 1 $ $ Sensus SRII Meter 25 1 $ $ 38 1 $ $ 50 1 $ $

16x19 1 $ $ 19 1 $ $ Neptune T-10 Meter 25 1 $ $ 38 1 $ $ 50 1 $ $

2.1 m – 2.5 m (depth) Type Meter Size (mm) Quantity Price 1 Price 2 16x19 1 $ $ 19 1 $ $ Sensus SRII Meter 25 1 $ $ 38 1 $ $ 50 1 $ $

16x19 1 $ $ 19 1 $ $ Neptune T-10 Meter 25 1 $ $ 38 1 $ $ 50 1 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 65 of 86 16x19 1 $ $ 19 1 $ $ Elster C-700 Meter 25 1 $ $ 38 1 $ $ 50 1 $ $ Sensus Omni Meter 50 1 $ $ Sensus iPERL Meter 19 5 $ $

14. No Maintenance Site Visit Quantity Price 1 50 $

15. Replace Measuring Chamber Type Size Quantity Price 1 Price 2 16x19 10 $ $ 19 10 $ $ Sensus SR 25 1 $ $ 38 1 $ $ 50 1 $ $

16x19 1 $ $ 19 1 $ $ Neptune T-10 25 1 $ $ 38 1 $ $ 50 1 $ $

16x19 1 $ $ 19 1 $ $ Elster C-700 25 1 $ $ 38 1 $ $ 50 1 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 66 of 86 16. Replace Meter Base Plates Type Size Quantity Price 1 Price 2 16x19 10 $ $ Sensus SR 19 1 $ $ 25 1 $ $

16x19 5 $ $ Neptune T-10 19 1 $ $ 25 1 $ $

16x19 5 $ $ Elster C-700 19 1 $ $ 25 1 $ $

17. Service Pipe Leak Repairs Type Size Quantity Price 1 Price 2 19 1 $ $ 25 1 $ $ Polyethylene Tubing 38 1 $ $ 50 1 $ $

19 1 $ $ 25 1 $ $ Copper Tubing 38 1 $ $ 50 1 $ $

19 1 $ $ 25 1 $ $ Galvanized Iron Tubing 38 1 $ $ 50 1 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 67 of 86 18. Meter Testing Type Size Quantity Price 16x19 1 $ 19 1 $ Field Testing 25 1 $ 38 1 $ 50 1 $

16x19 1 $ 19 1 $ Bench Testing 25 1 $ 38 1 $ 50 1 $

19. Confined Space Entry Price 1 Price 2 $ $ 20. Dewatering Meter Chamber Price 1 Price 2 $ $ 21. Line Freeze Price 1 Price 2 $ $

22. Curb Stop Maintenance Price 1 Price 2 $ $

Price 1 $

23. Re-Program Register

Price 1 Price 2 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 68 of 86 24. MXU Installation

Price 1 Price 2 $ $

25. Miscellaneous Work Description [Specify] Quantity Price 1 1 1 1 1 1

PART B – EMERGENCY WORK 1. Locate and Expose Buried Meter Box

Quantity Price 1 Price 2 10 $ $

2. Removals and Re-installation of Asphalt and Concrete Surfaces

Type Quantity Price 1 Price 2 Asphalt (Sq. Meter) 10 $ $ Concrete (Sq. meter) 10 $ $

3. Hazards and Debris Removal Type Quantity Price 1 Price 2

Debris (wood & dirt) 10 $ $ Needles & Syringes 10 $ $

4. Replace Wiring Type Quantity Price 1 Price 2

Replace damaged wiring 15 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 69 of 86 5. Lid Replacement Chamber Size Quantity Price 1 Price 2

300x500 10 $ $ 425x750 10 $ $ 600x900 10 $ $

6. Mount Pitpad Type Chamber Size Quantity Price 1 Price 2

300x500 10 $ $ Mount into Existing lid 425x750 10 $ $ 600x900 5 $ $

300x500 10 $ $ Mount with new lid 425x750 10 $ $ 600x900 5 $ $ 7. Replace Remote Receptacle

8. Relocate Remote Receptacle

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 70 of 86 9. Pre-Cast Concrete Meter Box Risers Type Size Quantity Price 1 Price 2

150mm 5 $ $ 300mmx500mm 300mm 4 $ $

150mm 5 $ $ 425mmx750mm 200mm 5 $ $ 250mm 5 $ $

150mm 4 $ $ 600mmx900mm 200mm 3 $ $ 250mm 2 $ $

9 a. HDPE Composite Meter Box Type Size Quantity Price 1 Price 2

Raven Products 300mm 5 $ $ 280mm x457mm 300mm EXT 4 $ $ 457mm 5 $ $

300mm 5 $ $ 430mm x760mm 300mm EXT 5 $ $ 457mm 5 $ $

10. Replace Register Type Meter Size (mm) Quantity Price 1 Price 2 16x19 30 $ $ 19 25 $ $ Sensus SRII Meter 25 10 $ $ 38 10 $ $ 50 10 $ $

16x19 30 $ $ 19 25 $ $ Neptune T-10 Meter 25 10 $ $ 38 10 $ $ 50 10 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 71 of 86 16x19 30 $ $ 19 25 $ $ Elster C-700 Meter 25 10 $ $ 38 10 $ $ 50 10 $ $ Sensus Omni Meter 50 10 $ $ 75 5 $ $ Neptune TT, HPT 100 5 $ $

11. Replace Water Meter

Type Meter Size (mm) Quantity Price 1 Price 2 16x19 6 $ $ 19 5 $ $ Sensus SRII Meter 25 4 $ $ 38 3 $ $ 50 2 $ $

16x19 6 $ $ 19 5 $ $ Neptune T-10 Meter 25 4 $ $ 38 3 $ $ 50 2 $ $

16x19 6 $ $ 19 5 $ $ Elster C-700 Meter 25 4 $ $ 38 3 $ $ 50 2 $ $ Sensus iPERL 19 50 $ $ SensusOmni Meter 50 10 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 72 of 86 12. Replace Meter Setter

Type Height (mm) Quantity Price 1 Price 2 Ford 70 Series 178 1 $ $ 228 1 $ $ 305 5 $ $ 16mm x19mm 381 1 $ $ 458 1 $ $ 533 1 $ $ 610 1 $ $

203 1 $ $ 305 5 $ $ 381 1 $ $ 19mm 457 1 $ $ 533 1 $ $ 610 1 $ $

254 1 $ $ 305 5 $ $ 381 1 $ $ 25mm 458 1 $ $ 534 1 $ $ 610 1 $ $

305 1 $ $ 381 1 $ $ 457 1 $ $ 38mm 533 1 $ $ 610 1 $ $ 686 1 $ $

305 1 $ $ 381 1 $ $ 50mm 457 1 $ $ 533 1 $ $ 610 1 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 73 of 86 12a.

Type Height (mm) Quantity Price 1 Price 2 Other Types Specify: (specify height in the appropriate box) 16mm x19mm 686mm to 1016mm 1 $ $ 19mm 686mm to 1016mm 1 $ $ 25mm 686mm to 1016mm 1 $ $ 38mm 686mm to 1016mm 1 $ $ 50mm 686mm to 1016mm 1 $ $

13. Replacement of Water Meter System

Type Meter Size (mm) Quantity Price 1 Price 2 0m – 1.5m (depth) 16x19 1 $ $ 19 1 $ $ Sensus SRII Meter 25 1 $ $ 38 1 $ $ 50 1 $ $

16x19 1 $ $ 19 1 $ $ Neptune T-10 Meter 25 1 $ $ 38 1 $ $ 50 1 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 74 of 86 13a. 1.6 m – 2.0 m (depth) Type Meter Size (mm) Quantity Price 1 Price 2 16x19 1 $ $ 19 1 $ $ Sensus SRII Meter 25 1 $ $ 38 1 $ $ 50 1 $ $

16x19 1 $ $ 19 1 $ $ Neptune T-10 Meter 25 1 $ $ 38 1 $ $ 50 1 $ $

2.1 m – 2.5 m (depth) Type Meter Size (mm) Quantity Price 1 Price 2 16x19 1 $ $ 19 1 $ $ Sensus SRII Meter 25 1 $ $ 38 1 $ $ 50 1 $ $

16x19 1 $ $ 19 1 $ $ Neptune T-10 Meter 25 1 $ $ 38 1 $ $ 50 1 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 75 of 86 16x19 1 $ $ 19 1 $ $ Elster C-700 Meter 25 1 $ $ 38 1 $ $ 50 1 $ $ Sensus Omni Meter 50 1 $ $ Sensus iPERL Meter 19 5 $ $

14. No Maintenance Site Visit Quantity Price 1 20 $

15. Replace Measuring Chamber Type Size Quantity Price 1 Price 2 16x19 1 $ $ 19 1 $ $ Sensus SR 25 1 $ $ 38 1 $ $ 50 1 $ $

16x19 1 $ $ 19 1 $ $ Neptune T-10 25 1 $ $ 38 1 $ $ 50 1 $ $

16x19 1 $ $ 19 1 $ $ Elster C-700 25 1 $ $ 38 1 $ $ 50 1 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 76 of 86 16. Replace Meter Base Plates Type Size Quantity Price 1 Price 2 16x19 10 $ $ Sensus SR 19 1 $ $ 25 1 $ $

16x19 5 $ $ Neptune T-10 19 1 $ $ 25 1 $ $

16x19 5 $ $ Elster C-700 19 1 $ $ 25 1 $ $

17. Service Pipe Leak Repairs Type Size Quantity Price 1 Price 2 19 1 $ $ 25 1 $ $ Polyethylene Tubing 38 1 $ $ 50 1 $ $

19 1 $ $ 25 1 $ $ Copper Tubing 38 1 $ $ 50 1 $ $

19 1 $ $ 25 1 $ $ Galvanized Iron Tubing 38 1 $ $ 50 1 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 77 of 86 18. Meter Testing Type Size Quantity Price 16x19 1 $ 19 1 $ Field Testing 25 1 $ 38 1 $ 50 1 $

16x19 1 $ 19 1 $ Bench Testing 25 1 $ 38 1 $ 50 1 $

19. Confined Space Entry Price 1 Price 2 $ $ 20. Dewatering Meter Chamber Price 1 Price 2 $ $

21. Line Freeze Price 1 Price 2 $ $

22. Curb Stop Maintenance Price 1 Price 2 $ $ 23. Re-Program Register

Price 1 Price 2 $ $

24. MXU Installation Price 1 Price 2 $ $

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 78 of 86 25. Miscellaneous Work Description [Specify] Quantity Price 1 1 1 1 1 1

SECTION B-3

Time Schedule:

9. Contractors should provide an estimated schedule, with major item descriptions and times indicating a commitment to provide the Goods and perform the Services within the time specified (use the spaces provided and/or attach additional pages, if necessary).

MILESTONE DATES ______

ACTIVITY SCHEDULE 1 2 3 4 5 6 7 8 9 10

SECTION B-4

Key Personnel & Sub-Contractors:

10. Contractor should provide information on the background and experience of all key personnel proposed to provide the Goods and Services (use the spaces provided and/or attach additional pages, if necessary):

Key Personnel

Name: Experience: Dates: Project Name: Responsibility:

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 79 of 86 11. Contractor should provide the following information on the background and experience of all sub -contractors and material suppliers proposed to undertake a portion of the Goods and Services (use the spaces provided and/or attach additional pages, if necessary):

Years Of Description Of Sub-Contractors & Telephone Number Working With Goods & Services Material Suppliers Names And Email Contractor

SECTION B-5

Experience and References:

12. Contractor's relevant experience and qualifications in delivering Goods and Services similar to those required by the Agreement (use the spaces provided and/or attach additional pages, if necessary):

13. Contractor's relevant references (name and telephone number) (use the spaces provided and/or attach additional pages, if necessary). The City's preference is to have a minimum of three references. Previous clients of the Contractor may be contacted at the City’s discretion.

14. Contractor to describe their sustainability initiatives relating to the environmental impacts. The environmental attributes (green) of their Goods and Services. Anticipated objectives (e.g. carbon neutral by 2015). Information pertaining to their environmental policies, programs and practices. Confirm that the Contractor complies with any applicable objective.

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 80 of 86 Metro Vancouver’s Non-Road Diesel Engine Emissions Regulation By-law:

15. Contractor should confirm they are in compliance with By-law (if applicable):

 Applicable as follows  Not applicable to this project

Equipment Description Engine Tier Engine Registration Designation Number as Issued by Metro Vancouver  Tier 0 or  Tier 1  Tier 0 or  Tier 1  Tier 0 or  Tier 1  Tier 0 or  Tier 1  Tier 0 or  Tier 1

16. I/We the undersigned duly authorized representatives of the Contractor, having received and carefully reviewed the RFQ and the Agreement, submit this Quotation in response to the RFQ.

This Quotation is offered by the Contractor this ______day of ______, 201_.

CONTRACTOR

I/We have the authority to bind the Contractor

______(Legal Name of Contractor)

______(Signature of Authorized Signatory) (Signature of Authorized Signatory)

______(Print Name and Position of Authorized Signatory) (Print Name and Position of Authorized Signatory)

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 81 of 86 ATTACHMENTS

RFQ Title: Water Meter Maintenance Services

RFQ No: 1220-040-2015-053

1. Prime Contractor Designation Letter of Understanding 2. Risk, Health & Safety 3. Compliance to Safety Procedure, Entry Procedure for Confined Space 4. Compliance to Safety Procedure, Working in Confined Space

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 82 of 86 Attachment # 1 PRIME CONTRACTOR DESIGNATION LETTER OF UNDERSTANDING

As per the requirements of the Workers’ Compensation Act Part 3, Division 3, Section 118 (1-3), which states: Coordination of multiple-employer workplaces 118 (1) In this section: “multiple-employer workplace” means a workplace where workers of 2 or more employers are working at the same time: “prime contractor” means, in relation to a multiple-employer workplace, (a) the directing contractor, employer or other person who enters into a written agreement with the owner of that workplace to be the prime contractor for the purposes of this Part, or (b) if there is no agreement referred to in paragraph (a), the owner of the workplace. (2) The prime contractor of a multiple-employer workplace must (a) ensure that the activities of employers, workers and other persons at the workplace relating to occupational health and safety are coordinated, and (b) do everything that is reasonably practicable to establish and maintain a system or process that will ensure compliance with this Part and the regulation in respect to the workplace. (3) Each employer of workers at a multiple-employer workplace must give to the prime contractor the name of the person the employer has designated to supervise the employer’s workers at that workplace. By signing this Agreement, the Contractor accepts all responsibilities of a prime contractor as outlined in the Workers’ Compensation Act, and WorksafeBC OH&S Regulation. As a Contractor signing this Prime Contractor Designation form with the City of Surrey (the “owner"), you are agreeing that your company, management staff, supervisory staff and workers will comply with the Workers’ Compensation Board (WCB) Occupational Health and Safety Regulation and the Workers’ Compensation (WC) Act. Any WorksafeBC OH&S violation by the prime contractor may be considered a breach of contract resulting in possible termination or suspension of the agreement and/or any other actions deemed appropriate at the discretion of the City. Any penalties, sanctions or additional costs levied against the City, as a result of the actions of the prime contractor are the responsibility of the prime contractor. The Contractor acknowledges having read and understood the information above. By signing this Prime Contractor Designation form, the Contractor agrees as a representative of the firm noted below, to accept all responsibilities of the prime contractor for this project. The Contractor understands and accepts the responsibilities of the prime contractor designation in accordance with the Workers’ Compensation Act while contracted by the City of Surrey for project and will abide by all Workers’ Compensation Board Regulation requirements. Project File No.: 1220-040-2015-053 Project Title and Site Location: ______Prime Contractor Name: ______Prime Contractor Address: ______Telephone/Fax Numbers: Phone: ______Fax: ______Name of Person in Charge of Project: ______Name of Person Responsible for Coordinating Health & Safety Activities: ______Phone: ______Prime Contractor Signature: ______Date: ______Please return a signed copy of this memo to the City of Surrey, Finance & Technology Department, Purchasing Section, 13450 – 104 Avenue, Surrey, British Columbia, V3T 1V8 If you have any questions, please contact the City of Surrey, Manager Occupational Health & Safety at 604-591-4658.

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 83 of 86 Attachment # 2

RISK, HEALTH & SAFETY Responsibility of Contractor(s)

The City of Surrey strives to maintain a safe work environment for employees and Contractors and insists upon the enforcement of safe practices and procedures in all premises and in all work activities. It is essential that all Contractors and their employees and sub-Contractor(s) perform in the same manner. As a Contractor to the City of Surrey, you are expected to conform to the requirements of the Workers’ Compensation Act, the WCB Occupational Health and Safety Regulation and to all federal, provincial and local laws and regulations. Any City of Surrey employee has the authority to order an unsafe act to cease or to have an unsafe piece of equipment removed from the premises or, in extreme situations, to shut down a job entirely. The following information is provided as typical City of Surrey requirements, but does not relieve the Contractor from complying with all applicable local, provincial and federal laws, regulations and bylaws. PERSONNEL

You are expected to inform your employees of any potential hazard in the workplace and advise of appropriate action to be taken should a hazard be found or a fire or accident occur. Contractors shall restrict persons invited on the premises to employees only. No families or friends are permitted. The Contractor shall advise the City of any on-site accidents involving the Contractor’s employees, or injuries to others caused by the Contractor’s business. GENERAL SAFETY RULES Horseplay, gambling and the use of alcohol or narcotics will not be tolerated. Orderliness and good housekeeping are basic requirements and must be maintained at all times. Any equipment, which could create a hazard, must be maintained in good condition. Restricted and controlled products shall be labeled, used and stored in accordance with the associated regulations, e.g. WHMIS. Contractors shall use a regular system of inspections to detect and correct hazardous conditions, safety violations and unsafe working practices on the job site. Contractors shall ensure their employees utilize proper safety equipment and clothing as required for job site activities. Contractors must follow and have on site proper written safe work procedures for hazardous work, e.g. confined space entry, lockout, excavations and shoring, etc. All ladders must be of an approved type and length. Unacceptable ladders must be removed immediately from the premises. All vehicles and equipment on City property must be kept in safe mechanical condition at all times, and be operated only by persons with a valid driver’s license and/or proper training and qualifications. Contractors shall not operate any equipment, valves, switches, etc., which are part of the City’s operation, unless specific permission is received from the City representative. Accumulation of oily rags, combustible refuse or similar fire hazards will not be tolerated. Your safety record and attitude are important criteria used to judge your qualification for future bidding on solicitations with the City of Surrey. You can help ensure employee safety and your eligibility for future business with the City if you exhibit and practice a “Safe Work - Safe City” attitude.

COMPLIANCE TO SAFETY PROCEDURE ENTRY PROCEDURE FOR CONFINED SPACE

This procedure shall be used as a guideline only. The Contractor shall be responsible for familiarization with this and all WCB requirements.

THERE MUST BE A MINIMUM OF TWO MEN - ONE MAN ALWAYS ON THE SURFACE, AND - ONE MAN IN THE WELL MAN LIFT/RETRIEVAL DEVICES MUST BE USED

1. a) Open manhole lids, turn on blower/fan to ventilate wet well for approximately two to three minutes. b) Leave fan funning until job is completed. c) Manhole must be circulated by a blower fan to allow fresh air into the confined space. Check levels on gas detector by lowering into well. If levels are not safe, portable fans MUST be used.

2. Turn gas detector “ON”:

* Oxygen levels should read between 20.0 to 21.0 * H2S levels should read 000 * LEL levels should read 000

NOTE: - Readings shall be taken before entering well. - Record gas levels on “Confined Entry Space” forms and hand in daily.

3. a) Lower gas detector by rope/cord into lower portion of wet well where work shall be performed. b) Pull detector to surface and check gas levels. If levels are safe, entry into well is permitted.

4. Gas detector MUST be left “ON” and brought down into well with person(s) entering.

5. Check levels on gas detector when in well. Proceed with washing/repairing of station.

6. If at any time the gas detector goes “OFF” (ringing), EXIT WET WELL IMMEDIATELY and check levels.

COMPLIANCE TO SAFETY PROCEDURE WORKING IN CONFINED SPACE

Where work is to be carried out, in any confined space where harmful atmosphere may develop, the following procedures must be followed: a) The space must be ventilated continuously. b) Gas detection equipment must be calibrated in an atmosphere that is known to be safe.

Tests for harmful or explosive substances and oxygen deficiency shall be made and recorded immediately prior to entry, after any interruptions in the work procedure and at intervals to ensure the continuing safety of the worker in the confined space.

If a harmful atmosphere develops, the worker will immediately evacuate the space and will not re-enter until it has been tested and found to be safe to do so. c) A safety belt or harness of a type which will keep the worker in a position to permit rescue, will be worn. d) A life line will be attached to the belt or harness which is tended at all times by another person stationed outside the entrance to the confined space, who shall be equipped for and capable of effecting rescue.

I, the undersigned, acknowledge having read and understand the information above.

By signing this Agreement, I agree as a representative of the firm noted below, to accept all responsibilities and compliant to all the Workers’ Compensation Board regulation requirements.

Project File No. 1220-040-2015-053

Company: ______

Project Title: ______

Signed: Date: (Company Owner)

Witness: Date:

Water Meter Maintenance Services RFQ #1220-040-2015-053 Page 86 of 86