Form 1 Fee Schedule Form

REQUEST FOR QUOTATION DOCUMENT TO PROVIDE SERVICES ON RETAINERPART C – FORMS AND NOTICESVERSION 1.9 May 2016 RFQ Retainer, Part C - Version 1.9 – May 2016 LIST OF FORMSForm 1 Fee Schedule Form Form 1(A) Offer and Acceptance Form 2A Work Item Order Form From 2B Work Item Quote Form Form 3A Certification – No Conflict of Interest Form 3B Certification – Conflict of Interest Form 4 List of Service Provider Staff Who Participated in Preparation of the RFQ Submission Form 5A Occupational Health & Safety Statutory Declaration Form 5B Occupational Health & Safety: Notice To Service Providers Form 5C Occupational Health & Safety: List of Designated Substances in Ministry Workplaces Form 6 Check List of Mandatory Documents Required for Quotation RFQ Retainer, Part C - Version 1.9 – May 2016 FORM 1: FEE SCHEDULE FORM – HIGHWAY ENGINEERINGAssignment #: insert numberTO: Her Majesty the Queen in right of Ontario as represented by the Ministry of Transportation (the “Ministry”).FROM: The Service ProviderADDRESS: TENDERThe 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 Quotations for the rates of:Highway Engineering Key Individual $ /hour For Engineering/Project Management $ /hour For Technical StaffThe Service Provider agrees that upon acceptance of this Tender by the Ministry, this Tender, the RFQ to which this Tender is attached, the successful Service Provider's Quotation and the Retainer Services Legal Agreement shall form a legally binding agreement.The rates quoted are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).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 Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Quotation Due Date.______Name of Signatory Date (Key Contact/Alternate Contact in RAQS)______Signature______Title Service Provider Firm Name RFQ Retainer, Part C - Version 1.9 – May 2016 FORM 1: FEE SCHEDULE FORM – BRIDGE ENGINEERINGAssignment #: insert number TO: Her Majesty the Queen in right of Ontario as represented by the Ministry of Transportation (the “Ministry”).FROM: The Service ProviderADDRESS: TENDERThe 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 rates of: Bridge Engineering Key Individual $ /hour For Structural Engineer - Bridge Inspection Work (Professional Engineer) $ /hour For Structural Engineer - Design Work (Professional Engineer) $ /hour For Structural Engineering Work (Technician) Material Testing (Bridge Deck Condition Survey) $ /each test For (1) Compressive Strength $ /each test For (2) Chloride Content $ /each test For (3) Air Void System The Service Provider agrees that upon acceptance of this Tender by the Ministry, this Tender, the RFQ to which this Tender is attached, the successful Service Provider's Quotation and the Retainer Services Legal Agreement shall form a legally binding agreement.The rates quoted are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).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. RFQ Retainer, Part C - Version 1.9 – May 2016 FORM 1: FEE SCHEDULE FORM – BRIDGE ENGINEERING (CONTINUED)Assignment #: insert numberThis Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Quotation Due Date.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:______Name of Signatory Date (Key Contact/Alternate Contact in RAQS)______Signature______Title Service Provider Firm Name FORM 1: FEE SCHEDULE FORM – GEOTECHNICAL ENGINEERINGAssignment #: insert numberTO: Her Majesty the Queen in right of Ontario as represented by the Ministry of Transportation (the “Ministry”).FROM: The Service ProviderADDRESS: TENDERThe 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 rates of:Geotechnical Key Individual $ /hr For Professional Engineer/Management $ /hr For Technical Staff Material Testing Soil Analysis: $ /ea. For Proctor $ /ea. For Grain Size Analysis - Sieve $ /ea. For Hydrometer $ /ea. For Field Moisture $ /ea. For Atterberg Limits Asphalt Analysis: $ /ea. For Gradation $ /ea. For Extraction Investigation: Boreholes: $ /ea. For Shallow (maximum depth 1.5 m) $ /ea. For Deep (maximum depth 3.0 mm) Pavement Core Holes (100 mm dia.): $ /ea. For Maximum Depth 200 mm $ /ea. For Maximum Depth 400 mm $ /ea. For Hand Auger HolesThe Service Provider agrees that upon acceptance of this Tender by the Ministry, this Tender, the RFQ to which this Tender is attached, the successful Service Provider's Quotation and the Retainer Services Legal Agreement shall form a legally binding agreement. RFQ Retainer, Part C - Version 1.9 – May 2016 FORM 1: FEE SCHEDULE FORM – GEOTECHNICAL ENGINEERING (CONTINUED)Assignment #:insert numberThe rates quoted are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).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 Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Quotation Due Date.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:______Name of Signatory Date (Key Contact/Alternate Contact in RAQS)______Signature______Title Service Provider Firm Name FORM 1: FEE SCHEDULE FORM – FOUNDATION ENGINEERINGAssignment #: insert numberTO: Her Majesty the Queen in right of Ontario as represented by the Ministry of Transportation (the “Ministry”).FROM: The Service ProviderADDRESS: TENDERThe 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 rates of:Foundations - Geotechnical Key Individual $ /hour For Investigation Phase $ /hour For Design PhaseThe Service Provider agrees that upon acceptance of this Tender by the Ministry, this Tender, the RFQ to which this Tender is attached, the successful Service Provider's Quotation and the Retainer Services Legal Agreement shall form a legally binding agreement.The rates quoted are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.)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 Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Quotation Due Date.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:______Name of Signatory Date (Key Contact/Alternate Contact in RAQS)______Signature______Title Service Provider Firm Name RFQ Retainer, Part C - Version 1.9 – May 2016 RFQ Retainer, Part C - Version 1.9 – May 2016 FORM 1: FEE SCHEDULE FORM – FISHERIES SERVICES AND AQUATIC ECOSYSTEM SERVICESAssignment #: insert numberTO: Her Majesty the Queen in right of Ontario as represented by the Ministry of Transportation (the “Ministry”).FROM: The Service ProviderADDRESS: TENDERThe 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 rates of:Rate Rate / Unit Fisheries and Aquatic Ecosystem Key Individual Services $ For Project Manager $ For Fisheries Biologist - Senior $ For Fisheries Biologist - Intermediate $ For Fisheries Biologist - Junior $ For Wildlife Biologist - Senior $ For Wildlife Biologist - Intermediate $ For Wildlife Biologist - Junior $ For Terrestrial Biologist - Senior $ For Terrestrial Biologist - Intermediate $ For Terrestrial Biologist - Junior $ For Fluvial Geomorphologist $ For Technician $ For CAD/GIS Technician $ For Equipment Rental (specify type) $ For Support Staff $ Other The Service Provider agrees that upon acceptance of this Tender by the Ministry, this Tender, the RFQ to which this Tender is attached, the successful Service Provider's Quotation and the Retainer Services Legal Agreement shall form a legally binding agreement.The rates quoted are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.). RFQ Retainer, Part C - Version 1.9 – May 2016 FORM 1: FEE SCHEDULE FORM – FISHERIES SERVICES AND AQUATIC ECOSYSTEM SERVICES (CONTINUED)Assignment #: insert numberThe 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 Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Quotation Due Date.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:______Name of Signatory Date (Key Contact/Alternate Contact in RAQS)______Signature______Title Service Provider Firm Name RFQ Retainer, Part C - Version 1.9 – May 2016 FORM 1: FEE SCHEDULE FORM – ELECTRICAL ENGINEERING (Also Includes Requirements for Traffic Engineer)Assignment #: insert numberTO: Her Majesty the Queen in right of Ontario as represented by the Ministry of Transportation (the “Ministry”).FROM: The Service ProviderADDRESS: TENDERThe 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 Quotations for the rates of:Electrical Engineering Key Individual $ /hour For a Project Manager $ /hour For a Traffic Engineer $ /hour For an Electrical Designer $ /hour For an Electrical Quality ControlThe Service Provider agrees that upon acceptance of this Tender by the Ministry, this Tender, the RFQ to which this Tender is attached, the successful Service Provider's Quotation and the Retainer Services Legal Agreement shall form a legally binding agreement.The rates quoted are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).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 Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Quotation Due Date. RFQ Retainer, Part C - Version 1.9 – May 2016 FORM 1: FEE SCHEDULE FORM – ELECTRICAL ENGINEERING (Also Includes Requirements for Traffic Engineer) (CONTINUED)Assignment #: insert numberI HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:______Name of Signatory Date (Key Contact/Alternate Contact in RAQS)______Signature______Title Service Provider Firm Name FORM 1: FEE SCHEDULE FORM – ARCHAEOLOGICAL SERVICESAssignment #: insert number TO: Her Majesty the Queen in right of Ontario as represented by the Ministry of Transportation (the “Ministry”). FROM: The Service Provider ADDRESS: TENDERThe 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 rates of:Assessment (includes expenses and Key Individual report) $ /hr For Project Manager $ /hr For Field archaeologist $ /hr For Field/Lab Technician $ /hr For Support Staff $ Sundry Expenses $ /hr For Aboriginal Monitor (Stage 3 and 4 work only) $ /hr For Contract Ploughing $ /hr For Heavy equipment Rental The Service Provider agrees that upon acceptance of this Tender by the Ministry, this Tender, the RFQ to which this Tender is attached, the successful Service Provider's Quotation and the Retainer Services Legal Agreement shall form a legally binding agreement.The rates quoted are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).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. RFQ Retainer, Part C - Version 1.9 – May 2016FORM 1: FEE SCHEDULE FORM – ARCHAEOLOGICAL SERVICES (CONTINUED)Assignment #: insert numberThis Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Quotation Due Date.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:______Name of Signatory Date (Key Contact/Alternate Contact in RAQS)______Signature______Title Service Provider Firm Name RFQ Retainer, Part C - Version 1.9 – May 2016FORM 1: FEE SCHEDULE – BUILT HERITAGE SERVICES Agreement #: insert numberTO: Her Majesty the Queen in right of Ontario as represented by the Ministry of Transportation (the “Ministry”).FROM: The ConsultantADDRESS: TENDERThe 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 rates of:Cost Rate Unit Task or Activity Key Individual (/day or /hour as applicable $ /hr For Project Manager $ /hr For Background/Historical Research $ /hr For Field Supervisor $ /hr For Field Technician $ /hr For Technical Staff $ /hr For CAD/Mapping/Cartography Services $ /hr For ResearcherThe Service Provider agrees that upon acceptance of this Tender by the Ministry, this Tender, the RFP to which this Tender is attached, the successful Service Provider's Quotation and the Retainer Services Legal Agreement shall form a legally binding agreement.The rates Proposed are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).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. RFQ Retainer, Part C - Version 1.9 – May 2016FORM 1: FEE SCHEDULE – BUILT HERITAGE SERVICES (CONTINUED)Agreement #: insert numberThis Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Quotation Due Date.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:______Name of Signatory Date (Key Contact/Alternate Contact in RAQS)______Signature______Title Service Provider Firm Name RFQ Retainer, Part C - Version 1.9 – May 2016FORM 1: FEE SCHEDULE FORM – WASTE MANAGEMENT SERVICESAssignment #: insert numberTO: Her Majesty the Queen in right of Ontario as represented by the Ministry of Transportation (the “Ministry”).FROM: The Service ProviderADDRESS: TENDERThe 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 rates of:Environmental – Waste Management Key Individual $ For Project Manager / Engineer $ For Senior Professional / Technical Staff $ For Technical Staff $ For Geophysical Survey1 $ For Backhoe/Excavator Services (including Mobilization/ Demobilization) $ For Drill Rig Services (including Mobilization/Demobilization) $ /hr For Track Mount Drill Rig (including Mobilization/Demobilization) $ /well For Monitoring Well Materials $ /day For Surveying Equipment $ /day For Gastechtor and Other Meter Rental $ /day Monitoring Well Record Reporting $ /day For Regulatory Request Fees $ /day For Regulatory Request Fees $ /day For Regulatory Request Fees RFQ Retainer, Part C - Version 1.9 – May 2016FORM 1: FEE SCHEDULE FORM – WASTE MANAGEMENT SERVICES (CONTINUED) Assignment #: insert numberEnvironmental – Waste Management - Laboratory Services –N/AParameter Unit Rates / Sample Name of Laboratory SOIL BTEX $ F1 to F4 Hydrocarbons $ PAH $ PCB $ VOC Scan $ Metals (including Pb and $ Hg) TCLP (for VOC) $ TCLP (full scan) $ WATER BTEX $ F1 to F4 Hydrocarbons $ Anion/Cation Scan2 $ General Chemistry3 $ PAH $ PCB $ VOC Scan $ Metals (including Pb and $ Hg) OTHER Asbestos $ Lead $ Notes:1. Include at a minimum an EM-31 terrain conductivity meter, grid-line spacing of no more than 5 meters, reading intervals of no more than 2 meters, and guaranteed position accuracy within 0.5- 1.0 meters. 2. Cl, NO2, NO3, SO4, PO4, F, Na, K, Ca, Mg, hardness, alkalinity 3. pH, conductivity, turbidity, TDS, TSS, DOCThe Service Provider agrees that upon acceptance of this Tender by the Ministry, this Tender, the RFQ to which this Tender is attached, the successful Consultant's Quotation and the Retainer Services Legal Agreement shall form a legally binding agreement.The rates quoted are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.). RFQ Retainer, Part C - Version 1.9 – May 2016FORM 1: FEE SCHEDULE FORM – WASTE MANAGEMENT SERVICES (CONTINUED) Assignment #: insert numberThe 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 Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Quotation Due Date.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:______Name of Signatory Date (Key Contact/Alternate Contact in RAQS)______Signature______Title Service Provider Firm Name RFQ Retainer, Part C - Version 1.9 – May 2016FORM 1: FEE SCHEDULE FORM – PROPERTY APPRAISALSAssignment #: insert numberTO: Her Majesty the Queen in right of Ontario as represented by the Ministry of Transportation (the “Ministry”).FROM: The Service ProviderADDRESS: TENDERThe 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 rates of:Property – Appraisals Key Individual $ /hour For Researcher $ /hour For Junior Appraiser $ /hour For Planner Services $ /hour For Senior (Accredited) Appraiser $ /hour For Supervisory/Management $ /hour For Clerical ServicesThe Service Provider agrees that upon acceptance of this Tender by the Ministry, this Tender, the RFQ to which this Tender is attached, the successful Service Provider’s Quotation and the Retainer Services Legal Agreement shall form a legally binding agreement.The rates quoted are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).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. RFQ Retainer, Part C - Version 1.9 – May 2016FORM 1: FEE SCHEDULE FORM – PROPERTY APPRAISALS (CONTINUED)Assignment #: insert numberThis Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Quotation Due Date.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:______Name of Signatory Date (Key Contact/Alternate Contact in RAQS)______Signature______Title Service Provider Firm Name FORM 1: FEE SCHEDULE FORM – LEGAL SURVEYSAssignment #: insert numberTO: Her Majesty the Queen in right of Ontario as represented by the Ministry of Transportation (the “Ministry”).FROM: The Service ProviderADDRESS: TENDERThe 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 rates of:ACTIVITY RATE Field Component Professional Supervision (inclusive of travel disbursements etc) $/hr 2-Person Field Crew (inclusive of all travel, mileage, disbursements $/hr and equipment costs etc) Office Component Professional Supervision (O.L.S.) $/hr Computations/Drafting (1 CAD Operator) $/hr Title Searching and / or Survey Records Research (hourly cost $/hr inclusive of travel/outsource disbursements if applicable etc) Expenses Survey Monument (SIB) + 2” x 2” x 4’ painted wooden stake, as a $18/unit combination unit Monument Protection Marker Post + Mounting hardware + sign, as a $20/Marker Post unit combination unit L.R.O. Plan Deposit Fee (Reference Plan or other Deposited Plan) + $200/Plan AOLS Plan Submission Sticker Fee + mylars + prints + courier costs per plan Expropriation or Crown Land Plan or other that MTO Registers - $100/Plan AOLS Plan Submission Sticker Fee + mylars + prints + courier costs per plan Ministry approval and receipt required for the following: Utility Locate Fees $__0____ Traffic Protection Fees $__0____ Railway Supervision Fees $__0____ Survey Records Retrieval Fee (Field Notes / unrecorded plans) $__0____ L.R.O. Document Retrieval Fee (PIN / Deed / Document / Plan) $__0____ FORM 1: FEE SCHEDULE FORM – LEGAL SURVEYS (CONTINUED)Assignment #: insert numberThe Service Provider agrees that upon acceptance of this Tender by the Ministry, this Tender, the RFQ to which this Tender is attached, the successful Service Provider’s Quotation and the Retainer Services Legal Agreement shall form a legally binding agreement.The rates quoted are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).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 Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Quotation Due Date.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:______Name of Signatory Date (Key Contact/Alternate Contact in RAQS)______Signature______Title Service Provider Firm Name FORM 1: FEE SCHEDULE FORM – ATMSAssignment #: insert numberTO: Her Majesty the Queen in right of Ontario as represented by the Ministry of Transportation (the “Ministry”).FROM: The Service ProviderADDRESS: TENDERThe 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 rates of:ATMS – Provision Management Key Individual $ /hour For Project Manager $ /hour For Technical StaffThe Service Provider agrees that upon acceptance of this Tender by the Ministry, this Tender, the RFQ to which this Tender is attached, the successful Service Provider's Quotation and the Retainer Services Legal Agreement shall form a legally binding agreement.The rates quoted are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).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. FORM 1: FEE SCHEDULE FORM – ATMS (CONTINUED)Assignment #: insert numberThis Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Quotation Due Date.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:______Name of Signatory Date (Key Contact/Alternate Contact in RAQS)______Signature______Title Service Provider Firm Name REQUEST FOR RETAINER QUOTATION FORM 1(A) - OFFER AND ACCEPTANCE Assignment Number: ______TO: Her Majesty the Queen in right of the Province of Ontario represented by the Minister of Transportation for the Province of Ontario (the "Ministry").FROM: ______(the "Service Provider")ADDRESS: ______OFFERThe Respondent hereby acknowledges that it has examined all the Retainer RFQ documents, including any addenda issued prior to the Quotation submission Deadline.The Respondent hereby offers to provide the Services and Deliverables specified in the Request for Quotation ("RFQ") for Retainer Services annexed hereto and forming part hereof in accordance with the RFQ, including the Terms and Conditions, for the Proposed Fees (Rates in Fee Schedules) submitted herewith, and agrees that upon acceptance of this Offer by the Ministry, this Offer, Form 1 (Fee Schedules) found in Part C of the Retainer RFQ and this RFQ shall form a legally binding agreement.The Proposed Fees listed above 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) calendar days following the deadline for submission of quotations.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:______Name of Signatory Date (Key Contact/Alternate Contact in RAQS)______Signature______Title Service Provider Firm Name ACCEPTANCEAssignment Number: ______The Ministry hereby accepts the Offer of the Service Provider to provide the Services and Deliverables specified in the Retainer RFQ annexed hereto and forming part hereof, in accordance with the Retainer RFQ, including the Terms and Conditions, and has caused its duly authorized official to execute this Acceptance this ______day of ______, ____.HER MAJESTY THE QUEEN in right of the Province of Ontario, represented by the Minister of Transportation for the Province of OntarioMTO ACCEPTANCE:Signatures of Authorized Ministry Personnel:Regional Director: ______Signature: ______Date: ______FORM 2A: WORK ITEM ORDER FORMAssignment #:insert numberORDERThe Ministry hereby issues to the Service Provider an Order to complete assignment no. insert number. The details of the assignment are as follows: insert sufficient details of the assignment to permit the successful Service provider to respond using an Assignment QuoteThe Service Provider shall immediately confirm its availability to the Ministry representative, and within two (2) business days of receiving this Order, shall provide the Ministry with an Assignment Quote containing its Lump Sum Price for this assignment.SIGNATURES OF AUTHORIZED MINISTRY PERSONNEL:Project Manager: ______Signature: ______Date: ______Functional Head: ______Signature: ______Date: ______FORM 2B: WORK ITEM QUOTE FORM – HIGHWAY ENGINEERING Assignment #: insert numberOFFERThe successful Service Provider hereby offers to complete assignment no. insert number, charging the Ministry only for the following at the rates specified in Form 1 of the Quotation:Time or ActivityQuantity Rate Total Activity Hrs $/hour $ For Engineering/ Project Management Hrs $/hour $ For Technical Staff TOTAL $ I/We hereby certify that (legal name of bidding company, at the time of submitting this quote have no conflict of interest in the performance of this assignment.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:Name of Authorized Signing Officer:______Signature: ______Date: ______MTO ACCEPTANCE:Signatures of Authorized Ministry Personnel:Regional Director/Manager: ______Signature: ______Date: ______FORM 2B: WORK ITEM QUOTE FORM – BRIDGE ENGINEERING Assignment #: insert numberOFFERThe successful Service Provider hereby offers to complete assignment no. insert number, charging the Ministry only for the following at the rates specified in Form 1 of the Quotation:Time or ActivityQuantity Rate Total Activity hours $/hr $ For Structural Engineer – Bridge Inspection Work (Professional Engineer) hours $/hr $ For Structural Engineer – Design Work (Professional Engineer) hours $/hr $ For Structural Engineering Work (Technician) km $/km $ For Travelling Material Testing (Bridge Deck Condition Survey) tests $/ea. $ For Compressive Strength tests $/ea. $ For Chloride Content tests $/ea. $ For Air void SystemTOTAL $ I/We hereby certify that (legal name of bidding company, at the time of submitting this quote have no conflict of interest in the performance of this assignment.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:Name of Authorized Signing Officer:______Signature: ______Date: ______MTO ACCEPTANCE:Signatures of Authorized Ministry Personnel:Regional Director/Manager: ______Signature: ______Date: ______FORM 2B: WORK ITEM QUOTE FORM – GEOTECHNICAL ENGINEERINGAssignment #: insert numberOFFERThe successful Service Provider hereby offers to complete assignment no. insert number, charging the Ministry only for the following at the rates specified in Form 1 of the Quotation: Time or Activity Quantity Rate Total Activity hrs $/hr $ For Professional Engineer/Management hrs $/hr $ For Technical Staff $/ea. $ For Proctor $/ea. $ For Grain Size Analysis – Sieve $/ea. $ For Hydrometer $/ea. $ For Field Moisture $/ea. $ For Atterberg Limits Asphalt Analysis: $/ea. $ For Gradation $/ea. $ For Extraction $/ea. $ For Shallow (maximum depth 1.5m) $/ea. $ For Deep (maximum depth 3.0mm) $/ea. $ For Maximum Depth 200mm $/ea. $ For Maximum Depth 400mm $/ea. $ for Hand Auger HolesTOTAL $ I/We hereby certify that (legal name of bidding company, at the time of submitting this quote have no conflict of interest in the performance of this assignment.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:Name of Authorized Signing Officer:______Signature: ______Date: ______MTO ACCEPTANCE:Signatures of Authorized Ministry Personnel:Regional Director/Manager: ______Signature: ______Date: ______RFQ Retainer, Part C - Version 1.9 – May 2016FORM 2B: WORK ITEM QUOTE FORM – FOUNDATION ENGINEERINGAssignment #: insert numberOFFERThe successful Service Provider hereby offers to complete assignment no. insert number, charging the Ministry only for the following at the rates specified in Form 1 of the Quotation:Time or ActivityQuantity Rate Total Activity Hrs $/hour $ For Investigation Phase Hrs $/hour $ For Design PhaseTOTAL $ I/We hereby certify that (legal name of bidding company, at the time of submitting this quote have no conflict of interest in the performance of this assignment.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:Name of Authorized Signing Officer:______Signature: ______Date: ______MTO ACCEPTANCE:Signatures of Authorized Ministry Personnel:Regional Director/Manager: ______Signature: ______Date: ______FORM 2B: WORK ITEM QUOTE FORM – FISHERIES SERVICES AND AQUATIC ECOSYSTEMAssignment #: insert numberOFFERThe successful Service Provider hereby offers to complete assignment no. insert number, charging the Ministry only for the following at the rates specified in Form 1 of the Quotation: Time or ActivityQuantity Rate Total Fisheries and Aquatic Ecosystem Services - Activities $ $ For Project Manager $ $ For Fisheries Biologist - Senior $ $ For Fisheries Biologist - Intermediate $ $ For Fisheries Biologist - Junior $ $ For Wildlife Biologist - Senior $ $ For Wildlife Biologist - Intermediate $ $ For Wildlife Biologist - Junior $ $ For Terrestrial Biologist - Senior $ $ For Terrestrial Biologist - Intermediate $ $ For Terrestrial Biologist - Junior $ $ For Fluvial Geomorphologies $ $ For Technician $ $ For CAD/GIS Technician $ $ For Support Staff $ $ For Equipment Rental (specify type) $ $ OtherTOTAL $ I/We hereby certify that (legal name of bidding company, at the time of submitting this quote have no conflict of interest in the performance of this assignment. RFQ Retainer, Part C - Version 1.9 – May 2016FORM 2B: WORK ITEM QUOTE FORM – FISHERIES SERVICES AND AQUATIC ECOSYSTEM (CONTINUED)Assignment #: insert numberI HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:Name of Authorized Signing Officer:______Signature: ______Date: ______MTO ACCEPTANCE:Signatures of Authorized Ministry Personnel:Regional Director/Manager: ______Signature: ______Date: ______FORM 2B: WORK ITEM QUOTE FORM – ELECTRICAL ENGINEERING (Also Includes Requirements for Traffic Engineer)Assignment #: insert numberOFFERThe successful Service Provider hereby offers to complete assignment no. insert number, charging the Ministry only for the following at the rates specified in Form 1 of the Quotation:Time or ActivityQuantity Rate Total Activity hrs $/hour $ For Project Manager hrs $hour $ For a Traffic Engineer hrs $hour $ For an Electrical Designer hrs $hour $ For an Electrical Quality ControlTOTAL $ I/We hereby certify that (legal name of bidding company, at the time of submitting this quote have no conflict of interest in the performance of this assignment.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:Name of Authorized Signing Officer:______Signature: ______Date: ______MTO ACCEPTANCE:Signatures of Authorized Ministry Personnel:Regional Director/Manager: ______Signature: ______Date: ______RFQ Retainer, Part C - Version 1.9 – May 2016FORM 2B: WORK ITEM QUOTE FORM – ARCHAEOLOGICAL SERVICES Assignment #: insert numberOFFERThe successful Service Provider hereby offers to complete assignment no. insert number, charging the Ministry only for the following at the rates specified in Form 1 of the Quotation:Time or ActivityQuantity Rate Total Activity $ $ Assessment (includes expenses and report) $ $ For Project Manager $ $ For Field Archaeologist $ $ For Field/Lab Technician $ $ For Support Staff $ $ Sundry Expenses $ $ For Aboriginal Monitor (Stage 3 and 4 work only) $ $ For Contract Ploughing $ $ For Heavy Equipment Rental TOTAL $I/We hereby certify that (legal name of bidding company, at the time of submitting this quote have no conflict of interest in the performance of this assignment.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:Name of Authorized Signing Officer:______Signature: ______Date: ______MTO ACCEPTANCE:Signatures of Authorized Ministry Personnel:Regional Director/Manager: ______Signature: ______Date: ______APPENDIX 2B: WORK ITEM QUOTE FORM – BUILT HERITAGE SERVICESAgreement #: insert numberOFFERThe successful Service Provider hereby offers to complete Work Item no. insert number, charging the Ministry only for the following (at the rates specified in Form 1 of the Quotation):Time or ActivityQuantity Rate Total Activity (/day or hour as applicable) $ $ For Project Manager $ $ For Background/Historical Research $ $ For Field Supervisor $ $ For Field Technician $ $ For Technical Staff $ $ For CAD / Mapping / Cartography Services $ $ For ResearcherTOTAL $ I/We hereby certify that (legal name of bidding company, at the time of submitting this quote have no conflict of interest in the performance of this assignment.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:Name of Authorized Signing Officer:______Signature: ______Date: ______MTO ACCEPTANCE:Signatures of Authorized Ministry Personnel:Regional Director/Manager: ______Signature: ______Date: ______RFQ Retainer, Part C - Version 1.9 – May 2016FORM 2B: WORK ITEM QUOTE FORM – WASTE MANAGEMENT SERVICESAssignment #: insert numberOFFERThe successful Service Provider hereby offers to complete assignment no. insert number, charging the Ministry only for the following at the rates specified in Form 1 of the Quotation:Time or ActivityQuantity Rate Total Activity hrs $/hr $ Environmental - Waste Management hrs $/hr $ For Project Manager / Engineer hrs $/hr $ For Senior Professional / Technical Staff acres $/acre $ For Technical Staff hrs $/hr $ For Geophysical Survey1 hrs $/hr $ For Backhoe / Excavator Services (including Mobilization/Immobilization) hrs $/hr $ For Drill Rig Services (including Mobilization/Immobilization) wells $/well $ For Track Mount Drill Rig (including Mobilization/ Demobilization) days $/day $ For Monitoring Well Materials days $/day $ For Surveying Equipment wells $/well $ For Gastechtor and Other Meter Rental searches $/search $ Monitoring Well Record Reporting plans $/plan $ For Regulatory Request Fees reports $/report $ For Regulatory Request Fees hrs $/hr $ For Regulatory Request FeesEnvironmental – Waste Management - Laboratory Services – N/A Parameter Unit Rates / Sample Name of Laboratory SOIL BTEX $ F1 to F4 Hydrocarbons $ PAH $ PCB $ VOC Scan $ Metals (including Pb and $ Hg) TCLP (for VOC) $ TCLP (full scan) $ WATER BTEX $ F1 to F4 Hydrocarbons $ Anion/Cation Scan2 $ Environmental – Waste Management - Laboratory Services – N/A Parameter Unit Rates / Sample Name of Laboratory General Chemistry3 $ PAH $ PCB $ VOC Scan $ Metals (including Pb and $ Hg) OTHER Asbestos $ Lead $ TOTAL $Notes:1. Include at a minimum an EM-31 terrain conductivity meter, grid-line spacing of no more than 5 meters, reading intervals of no more than 2 meters, and guaranteed position accuracy within 0.5-1.0 meters. 2. Cl, NO2, NO3, SO4, PO4, F, Na, K, Ca, Mg, hardness, alkalinity 3. pH, conductivity, turbidity, TDS, TSS, DOCI/We hereby certify that (legal name of bidding company, at the time of submitting this quote have no conflict of interest in the performance of this assignment. RFQ Retainer, Part C - Version 1.9 – May 2016FORM 2B: WORK ITEM QUOTE FORM – WASTE MANAGEMENT SERVICES (CONTINUED)Assignment #: insert numberI HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:Name of Authorized Signing Officer:______Signature: ______Date: ______MTO ACCEPTANCE:Signatures of Authorized Ministry Personnel:Regional Director/Manager: ______Signature: ______Date: ______FORM 2B: WORK ITEM QUOTE FORM – PROPERTY APPRAISALS Assignment #: insert numberOFFERThe successful Service Provider hereby offers to complete assignment no. insert number, charging the Ministry only for the following at the rates specified in Form 1 of the Quotation:Time or ActivityQuantity Rate Total Activity hrs $/hour $ For Researcher hrs $/hour $ For Junior Appraiser hrs $/hour $ For Planner Services hrs $/hour $ For Senior (Accredited) Appraiser hrs $/hour $ For Supervisory/Management hrs $/hour $ For Clerical ServicesTOTAL $ I/We hereby certify that (legal name of bidding company, at the time of submitting this quote have no conflict of interest in the performance of this assignment.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:Name of Authorized Signing Officer:______Signature: ______Date: ______MTO ACCEPTANCE:Signatures of Authorized Ministry Personnel:Regional Director/Manager: ______Signature: ______RFQ Retainer, Part C - Version 1.9 – May 2016Date: ______RFQ Retainer, Part C - Version 1.9 – May 2016FORM 2B: WORK ITEM QUOTE FORM – LEGAL SURVEYSAssignment #: insert numberOFFERThe successful Service Provider hereby offers to complete assignment no. insert number, charging the Ministry only for the following at the rates specified in Form 1 of the Quotation:Time or ActivityACTIVITY Rate Quantity Total Field Component Professional Supervision (inclusive of disbursements $ /hr hrs etc) 2-Person Field Crew (inclusive of all travel, mileage, $ /hr hrs disbursements and equipment costs) Office Component Professional Supervision (O.L.S.) $ /hr hrs Computations/Drafting (1 CAD Operator) $ /hr hrs Title Searching and / or Survey Records Research $ /hr hrs Expenses Survey Monument (SIB) + 2” x 2” x 4’ painted $18/unit wooden stake as a combination unit Monument Protection Marker Post + Mounting $20/unit hardware + sign, as a combination unit L.R.O. Plan Deposit Fee (Reference Plan or other $200/Plan Deposited Plan) + AOLS Plan Submission Sticker Fee + mylars + prints + courier costs per plan Expropriation or Crown Land Plan or other that MTO $100/Plan Registers - AOLS Plan Submission Sticker Fee + mylars + prints + courier costs per plan Ministry approval and receipt required for the following: $______Utility Locate Fees $______Traffic Protection Fees $______Railway Supervision Fees Survey Records Retrieval Fee (Field Notes / $______unrecorded plans) $______L.R.O. Document Retrieval Fee (PIN / Deed Document / Plan)TOTAL $ I/We hereby certify that (legal name of bidding company, at the time of submitting this quote have no conflict of interest in the performance of this assignment. RFQ Retainer, Part C - Version 1.9 – May 2016FORM 2B: WORK ITEM QUOTE FORM – LEGAL SURVEYS (CONTINUED)Assignment #: insert numberI HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:Name of Authorized Signing Officer:______Signature: ______Date: ______MTO ACCEPTANCE:Signatures of Authorized Ministry Personnel:Regional Director/Manager: ______Signature: ______Date: ______RFQ Retainer, Part C - Version 1.9 – May 2016FORM 2B: WORK ITEM QUOTE FORM – ATMSAssignment #: insert numberOFFERThe successful Service Provider hereby offers to complete assignment no. insert number, charging the Ministry only for the following at the rates specified in Form 1 of the Quotation:Time or ActivityQuantity Rate Total Activity hrs $/hour $ For Project Manager hrs $/hour $ For Technical StaffTOTAL $ I/We hereby certify that (legal name of bidding company, at the time of submitting this quote have no conflict of interest in the performance of this assignment.I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:Name of Authorized Signing Officer:______Signature: ______Date: ______MTO ACCEPTANCE:Signatures of Authorized Ministry Personnel:Regional Director/Manager: ______Signature: ______Date: ______RFQ Retainer, Part C - Version 1.9 – May 2016FORM 3A: CERTIFICATION - NO CONFLICT OF INTEREST(Complete 3A or 3B - Do Not Complete Both) Assignment #:insert numberI/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.______Name of Signatory Signature______Position Date FORM 3B: CERTIFICATION - CONFLICT OF INTEREST (Complete 3A or 3B - Do Not Complete Both)Assignment #:insert numberIn 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 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 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 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 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.______Name of Signatory Signature______Position Date FORM 4: LIST OF SERVICE PROVIDER STAFF WHO PARTICIPATED IN PREPARATION OF THE RFQ SUBMISSIONBusiness Contribution Or Name Business Address Telephone % Of Work Number FORM 5A: OCCUPATIONAL HEALTH AND SAFETY STATUTORY DECLARATIONIn submitting this Quotation, I/We, on behalf of (legal name of bidding company) certify the following:(a) I/We have a health and safety policy and will maintain a program to implement such policy as required by clause 25(2)(j) the Occupational Health and Safety Act, R.S.O. 1990, c.O.1, as amended, (the "OHSA").The requirements in (a) do not apply to employers with five (5) or less employees.(b) With respect to the services being offered in this Quotation, I/we and our proposed sub-contractors, acknowledge the responsibility to, and shall:(i) fulfill all of the obligations under the OHSA and make reasonable efforts 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 thatthey 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 ______200__I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:Name of Authorized Signing Officer: ______Signature: ______Date: ______FORM 5B: OCCUPATIONAL HEALTH AND SAFETY: NOTICE TO SERVICE PROVIDERSThe Ministry of Transportation was issued an Order by the Ministry of Labour. The Order reads "Except in an emergency the employer shall, by 01 March 96, not permit a worker on a 400-series highway in Central Region to work within 10 feet or 3 metres of moving traffic unless protected by a guard or other device from moving traffic.""Emergency" is described as assisting an injured person or clearing debris that represents an immediate or serious hazard to public safety. "Serious" is that which would affect the movement of a vehicle."400-series highway" has been changed to "freeway" as defined by Ontario Traffic Manual Book 7 - Temporary Conditions."Guard or other device" includes a crash truck, a guide rail, barrier or other physical barrier or by distance such that a worker cannot be struck by a moving vehicle or another vehicle in motion as a result of being struck."Work" is not considered to include getting in/out of vehicles nor the removal or replacement of equipment. If work is being carried out behind a guide rail, barrier or at a distance of greater than 3 metres of a travelled lane, a crash truck would not be required. FORM 5C: OCCUPATIONAL HEALTH AND SAFETY: LIST OF DESIGNATED SUBSTANCES IN MINISTRY WORKPLACESAssignment #:insert numberIn accordance with the OHSA, a list of Designated Substances present in Ministry workplaces is provided in this section.Ontario Regulation 490/09 lists the following eleven Designated Substances: Acrylonitrile, Arsenic, Asbestos, Benzene, Coke Oven emissions, Ethylene Oxide, Isocyanates, Lead, Mercury, Silica, Vinyl Chloride.Of the above, MTO is aware that Silica, Lead, Asbestos and Arsenic were widely used in highway and bridge construction in the past and may be present within the project limits. In addition, there is a possibility that Benzene may be present in certain coating materials (such as coal tar epoxy) or as a result from a spill or from contamination from an adjacent property.The remaining Designated Substances are not likely to be encountered in typical construction or maintenance activities of MTO infrastructure. Acrylonitrile and Vinyl Chloride are in Acrylonitrile Butadiene Styrene (ABS) and Polyvinyl Chloride (PVC) materials but are not considered Designated Substances once they have been polymerized and therefore do not need to be identified.In accordance to the Occupational Health and Safety Act, R.S.O. 1990, c. 0.1, Proponents are advised of the presence of the Designated Substances presented in Table 2-1 to which the Service Provider may be exposed when working at the specified locations or while the specified work activities are being undertaken. Table 2-1 Designated Substances In Ministry WorkplacesDesignated Location or Work Activity Substance Handling sand or gravel. Handling road sweeping materials.Silica Silica will be present on all projects. Present throughout the working area including, but not limited to, asphalt, concrete, and granular materials. Lead is assumed to be present in the epoxy coating on the Lead reinforcing steel within the concrete deck and the work shall be performed as though lead is present. Designated Location or Work Activity Substance Patrol yard building materials (i.e., pipe insulation, ceiling/beam insulation, ceiling tiles, acoustic wallboards, floor tiles, ducts in bridges, etc.). Located on the X Bridge in the Bearings identified as Transite Board. Material is non-friable. Reference report “Asbestos Analysis for the X Bridge” dated May 2013 and included elsewhere in the Contract Documents. Asbestos on The conduit in the sidewalk of the bridge is assumed to contain Construction asbestos and is assumed to be non-friable; however it shall be Projects and in re-assessed when the material is exposed. Buildings and Repair Asbestos may be found in some pavements, bridges, culverts, Operations buildings, and electrical works: (O. Reg. 278/0 5) - Asbestos may be found in conduits/ducts, bearings as well as in coatings found on structures and culverts. - Asphalt Coated Asbestos Protected Corrugated Steel Culverts have been used in some projects. - Asbestos may also be present as insulation and in numerous other building materials in existing buildings. Examples include: caulking, drywall joint compound, tiles, etc. - Asbestos was used as a hot mix additive in some trials. - Asbestos cement pipes may also have been used. Manometers, thermometers or other pressure or temperature sensing devices may contain mercury.Steel Structure coatings may contain small concentrations of mercury.Mercury Mercury is not likely to be encountered as mercury vapour lamps have been replaced with high pressure sodium and LED for illumination. However mercury may be present in some electrical equipment and mercury vapour is present in fluorescent light tubes and other types of light fixtures in buildings. Steel Structure coatings may contain small concentrations of arsenic. Arsenic May be found in pressure treated lumber (e.g. sign supports and some guiderail posts) and some steel structure coatings. Benzene may be present in certain coating materials such as coal tar epoxy. Benzene Benzene may also be encountered in or adjacent to abandoned fuel storage facilities. Designated Location or Work Activity Substance Vinyl Chloride, Coke Oven Emissions, Vinyl Chloride, Coke Oven Emissions, Ethylene Oxide, Ethylene Acrylonitrile and Isocyanates are not normally present on MTO Oxide, construction projects. Acrylonitrile and IsocyanatesNote to User: The Agreement Administrator is to review Table 2.3 and adjust the “Location or Work Activity” table for the project specific requirements for this Assignment FORM 6: CHECK LIST OF MANDATORY DOCUMENTS REQUIRED FOR QUOTATIONEach 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 IncludedCover Letter Signed by Key Contact / Alternate Contact in RAQSService Provider’s Organizational StructureOccupational Health & Safety Statutory Declaration FormOccupational Health and Safety Plan Submitted by Successful Service Provider (s) upon awardConflict of Interest Declaration FormsStatement of acceptability of the Service Provider Retainer Services Legal Agreement, or a list of all material alterations, which the Respondent requires to execute the Agreement.Quality Control of Services PlanFee ScheduleRAQS Declaration FormI HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:______Name of Signatory Date (Key Contact/Alternate Contact in RAQS)______Signature______Title Service Provider Firm Name

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