RFP Retainer Appendices Index

RFP Retainer Version 5.9 JUNE 2011 Appendices

RFP Retainer Appendices Index

Appendix 1Fee Schedule

Appendix 2Tax Compliance Declaration

Appendix 3AWork Item Order Form

Appendix 3BWork Item Quote Form

Appendix 4AClarification – No Conflict of Interest

Appendix 4BClarification – Conflict of Interest

Appendix 4CList of Service Provider Staff Who Participated in Preparation of the RFP Submission

Appendix 5AOccupational Health and Safety Statutory Declaration

Appendix 5BOccupational Health and Safety: Notice to Service Providers

Appendix 5COccupational Health and Safety: List of Designated Substances in Ministry Workplaces

Appendix 5DOccupational Health and Safety: MOL Orders

Appendix 6 Check List of Mandatory Documents for RFP

APPENDIX 1: FEE SCHEDULE – HIGHWAY ENGINEERING

Agreement #: 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:

TENDER

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

Highway Engineering / Key Individual
$ / /hour / for Engineering/Project Management
$ / /hour / for Technical Staff

The 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 Proposal and the Retainer Services Legal Agreement shall form a legally binding agreement.

The above totals do 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.

The rates Proposed are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).

This Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Proposal Due Date.

I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:

______

Name of SignatoryDate

(Key Contact/Alternate Contact in RAQS)

______

Signature

______

Title Service Provider Firm Name

APPENDIX 1: FEE SCHEDULE – BRIDGE ENGINEERING

Agreement #: 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:

TENDER

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

Bridge Engineering / Key Individual
$ / /hour / Structural Engineer – Bridge Inspection Work (Professional Engineer)
$ / /hour / for Structural Engineer – Design Work (Professional Engineer)
$ / /hour / Structural Engineering Work (Technician)
Material Testing (Bridge Deck Condition Survey)
$ / /test / for (1) Compressive Strength
$ / /test / for (2) Chloride Content
$ / /test / for (3) Air void System

The rates Proposed are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).

The above totals do not include HST.

This Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Proposal Due Date.

I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:

______

Name of SignatoryDate

(Key Contact/Alternate Contact in RAQS)

______

Signature

______

Title Service Provider Firm Name

APPENDIX 1: FEE SCHEDULE – GEOTECHNICAL ENGINEERING

Agreement #: 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:

TENDER

The Service Provider hereby tenders and offers to enter into a contract to provide the RETAINER Services specified in the Legal Agreement and this Request for Proposal 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 Holes

The rates Proposed are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).

The above totals do not include HST.

APPENDIX 1: FEE SCHEDULE – GEOTECHNICAL ENGINEERING

(continued)

Agreement #: insert number

This Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Proposal Due Date.

I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:

______

Name of SignatoryDate

(Key Contact/Alternate Contact in RAQS)

______

Signature

______

Title Service Provider Firm Name

APPENDIX 1: FEE SCHEDULE – FOUNDATION ENGINEERING

Agreement #: 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:

TENDER

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

Foundations - Geotechnical / Key Individual
$ / /hour / For Investigation Phase
$ / /hour / For Design Phase

The rates Proposed are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).

The above totals do not include HST.

This Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Proposal Due Date.

I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:

______

Name of SignatoryDate

(Key Contact/Alternate Contact in RAQS)

______

Signature

______

Title Service Provider Firm Name

APPENDIX 1: FEE SCHEDULE – ELECTRICAL ENGINEERING

(Also Includes Requirements for Traffic Engineer)

Agreement #: 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:

TENDER

The Service Provider hereby tenders and offers to enter into a contract to provide the RETAINER Services specified in the Legal Agreement and this Request for 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 Control

The rates Proposed are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).

The above totals do not include HST.

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 SignatoryDate

(Key Contact/Alternate Contact in RAQS)

______

Signature

______

Title Service Provider Firm Name

APPENDIX 1: FEE SCHEDULE – FISHERIES AND AQUATIC ECOSYSTEM SERVICES

Agreement #: 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:

TENDER

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

Rate / Rate / Unit / –Fisheries and Aquatic Ecosystem Services / Key Individual
$ / /hour / For Project Manager
$ / /hour / For Fisheries Biologist – Senior
$ / /hour / For Fisheries Biologist - Intermediate
$ / /hour / For Fisheries Biologist - Junior
$ / /hour / For Fluvial Geomorphologist
$ / /hour / For Technician
$ / /hour / For Equipment Rental (specify type)
$ / /hour / For Support Staff
$ / /hour / Other

The rates Proposed are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).

The above totals do not include HST.

This Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Proposal Due Date.

I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:

______

Name of SignatoryDate

(Key Contact/Alternate Contact in RAQS)

______

Signature

______

Title Service Provider Firm Name

APPENDIX 1: FEE SCHEDULE – ARCHAEOLOGICAL SERVICES

Agreement #: 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:

TENDER

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

Assessment (includes expenses and report) / Key Individual
$ / /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 rates Proposed are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).

The above totals do not include HST.

This Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Proposal Due Date.

I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:

______

Name of SignatoryDate

(Key Contact/Alternate Contact in RAQS)

______

Signature

______

Title Service Provider Firm Name

APPENDIX 1: FEE SCHEDULE – BUILT HERITAGE SERVICES

Agreement #: 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:

TENDER

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

Cost / Rate Unit (/day or /hour as applicable / Task or Activity / Key Individual
$ / /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 Researcher

The rates Proposed are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).

The above totals do not include HST.

This Tender shall be irrevocable and open for acceptance for a period of ninety (90) calendar days following the Proposal Due Date.

I HAVE AUTHORITY TO BIND THE SERVICE PROVIDER:

______

Name of SignatoryDate

(Key Contact/Alternate Contact in RAQS)

______

Signature

______

Title Service Provider Firm Name

APPENDIX 1: FEE SCHEDULE – WASTE MANAGEMENT SERVICES

Agreement #: 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:

TENDER

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

Cost/Rate / Rate Unit / Environmental – Waste Management / Key Individual
$ / /hr / For Project Manager / Engineer
$ / /hr / For Senior Professional / Technical Staff
$ / /hr / For Technical Staff
$ / /site / For Geophysical Survey1
$ / /hr / For Backhoe/Excavator Services (including mobilization/demobilization)
$ / /hr / For Drill Rig Services (including mobilization/demobilization)
$ / /hr / For Track Mount Drill Fig (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
Environmental – Waste Management - Laboratory Services
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 / $
General Chemistry3 / $
PAH / $
PCB / $
VOC Scan / $
Metals (including Pb and Hg) / $
OTHER
Asbestos / $
Lead / $

APPENDIX 1: FEE SCHEDULE – WASTE MANAGEMENT SERVICES

(Continued)

Agreement #: insert number

Notes:

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.
Cl, NO2, NO3, SO4, PO4, F, Na, K, Ca, Mg, hardness, alkalinity
pH, conductivity, turbidity, TDS, TSS, DOC

The rates Proposed are to be inclusive of all operating costs and disbursements (supplies, equipment, vehicles, fuel, travel, meals, etc.).

The above totals do not include HST.