SCHEDULE C – FORM OF PROPOSAL
RFP Project Title:
Employee & Family Assistance Program
RFP Reference No.:
1220-030-2015-030
Legal Name of Proponent:
Contact Person and Title:
Business Address:
Telephone:
Fax:
E-Mail Address:
TO:
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: purchasing@surrey.ca
Dear Sir:
1.0
I/We, the undersigned duly authorized representative of the Proponent, having received and
carefully reviewed all of the Proposal documents, including the RFP and any issued addenda posted on
the City Website and BC Bid Website, and having full knowledge of the Site, and having fully informed
ourselves as to the intent, difficulties, facilities and local conditions attendant to performing the
Services, submit this Proposal in response to the RFP.
2.0
I/We confirm that the following schedules are attached to and form a part of this Proposal:
Schedule C-1 – Statement of Departures;
Schedule C-2 – Proponent’s Experience, Reputation and Resources;
Schedule C-3 – Proponent’s Technical Proposal (Services);
Schedule C-4 – Proponent's Technical Proposal (Time Schedule); and
Schedule C-5 – Proponent’s Financial Proposal.
3.0
I/We confirm that this proposal is accurate and true to best of my/our knowledge.
Employee & Family Assistance Program, RFP #1220-030-2015-030
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4.0
I/We confirm that, if I/we am/are awarded a contract, I/we will at all times be the “prime
contractor” as provided by the Worker's Compensation Act (British Columbia) with respect to the
Services. I/we further confirm that if I/we become aware that another consultant at the place(s) of the
Services has been designated as the “prime contractor”, I/we will notify the City immediately, and I/we
will indemnify and hold the City harmless against any claims, demands, losses, damages, costs,
liabilities or expenses suffered by the City in connection with any failure to so notify the City.
This Proposal is submitted this [day] day of [month], [year].
I/We have the authority to bind the Proponent.
________________________________________
(Legal Name of Proponent)
_________________________________________ ________________________________________
(Signature of Authorized Signatory)
(Signature of Authorized Signatory)
_________________________________________ ________________________________________
(Print Name and Position of Authorized Signatory)
(Print Name and Position of Authorized Signatory)
Employee & Family Assistance Program, RFP #1220-030-2015-030
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SCHEDULE C-1 - STATEMENT OF DEPARTURES
1.
I/We have reviewed the proposed Contract attached to the RFP as Schedule “B”. If requested
by the City, I/we would be prepared to enter into that Contract, amended by the following
departures (list, if any):
Section
Requested Departure(s) / Alternative(s)
______________________________________________________________________
______________________________________________________________________
2.
The City of Surrey requires that the successful Proponent have the following in place before
commencing the 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 at www.surrey.ca search
Consultants Certificate of Insurance;
(d)
City of Surrey or Intermunicipal Business License: Number ________________;
(e)
If the Consultant’s Goods and Services are subject to GST, the Consultant’s GST
Number is _____________________________________; and
(f)
If the Consultant 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 Proposal, we advise that we have the ability to meet all of the above
requirements except as follows (list, if any):
Section
Requested Departure(s) / Alternative(s)
______________________________________________________________________
______________________________________________________________________
3.
I/We offer the following alternates to improve the Services described in the RFP (list, if any):
Section
Requested Departure(s) / Alternative(s)
______________________________________________________________________
______________________________________________________________________
4.
The Proponent acknowledges that the departures it has requested in Sections 1, 2 and 3 of this
Schedule C-1 will not form part of the Contract unless and until the City agrees to them in
writing by initialling or otherwise specifically consenting in writing to be bound by any of them.
Employee & Family Assistance Program, RFP #1220-030-2015-030
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SCHEDULE C-2 - PROPONENT’S EXPERIENCE, REPUTATION AND RESOURCES
Proponents should provide information on the following (use the spaces provided and/or attach
additional pages, if necessary):
(i)
Location of primary business, branch locations, background, stability, structure of the
Proponent and number of years business has been operational;
(ii)
Proponent’s relevant experience and qualifications in delivering Services similar to those
required by the RFP;
(iii)
Proponent’s demonstrated ability to provide the Services;
(iv)
Proponent’s equipment resources, capability and capacity, as relevant;
(v)
Proponent’s references (name and telephone number). The City's preference is to have
a minimum of three references. Provide contact information and names of corporate
clients (government preferred). Proponent is currently supplying same or similar
Services to;
(vi)
Proponent’s financial strength (with evidence such as financial statements, bank
references);
(vii)
Describe any difficulties or challenges you might anticipate in providing the Services to
the City and how you would plan to manage these;
(viii)
Describe specific expertise your firm may have in assessing Clients’ needs and referring
them to others;
(ix)
Describe any plans you would have for keeping abreast of changes in the particular
fields and how you would ensure provision of adequate counselling services. List all
relevant memberships;
(x)
Proponents should provide information on the background and experience of all key
personnel proposed to undertake the Services (use the spaces provided and/or attach
additional pages, if necessary):
Key Personnel
Name:
Experience:
Dates:
Project Name:
Responsibility:
Dates:
Employee & Family Assistance Program, RFP #1220-030-2015-030
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Project Name:
Responsibility:
Dates:
Project Name:
Responsibility:
Sub-Consultants
(xi)
Proponents should provide the following information on the background and experience
of all sub-consultants proposed to undertake a portion of the Services (use the spaces
provided and/or attach additional pages, if necessary):
DESCRIPTION OF SERVICES
SUB-CONSULTANTS
NAME
Employee & Family Assistance Program, RFP #1220-030-2015-030
YEARS OF
WORKING WITH
CONSULTANT
TELEPHONE
NUMBER AND EMAIL
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SCHEDULE C-3 - PROPONENT’S TECHNICAL PROPOSAL (SERVICES)
Proponents should provide the following (use the spaces provided and/or attach additional
pages, if necessary):
(i)
Services
Provide a narrative that illustrates an understanding of the City’s requirements and
Services for EFAP as described in Schedule A – Scope of Services:
a) Describe the approach and methodology;
b) Describe how the Proponent will complete the scope of Services, manage the
Services, and accomplish required objectives within the City’s schedule;
Describe how the following Services would be provided:
(ii)
Assessment
a) Assessment of Clients and referral to the appropriate service or agency, i.e.
standardized early intervention and treatment protocols that enable employees to
receive fast, effective treatment for anxiety-related disorders and depression;
b) Flexibility of appointment hours and locations, including neutral locations and in rare
circumstances, the Client’s residence;
c) List the categories of service and the recommended number of sessions; and
d) What is the reasoning behind the choice? What flexibility is there with the number of
sessions?
e) Describe the assessment, referral counselling and other technical services that you
would be able to provide to clients, and the timeline for the first appointment. Please
provide a complete list of all organizations and entities to which you refer Clients.
(iii)
Counselling Services
a) Choice of counsellor, including counsellor’s gender, if requested;
b) Unqualified and guaranteed confidentiality;
c) Annual meetings with the two EFAP committees to review statistics;
d) Assistance with the Client return-to-work process in conjunction with the City’s Return
to Work Coordinator, Occupational Health & Safety Advisor, and
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e) Describe how you would handle situations where Clients request their own preferred
practitioner. Describe how special requests as to the gender, age or specialty of
practitioners would be handled.
(iv)
Referral
a) Provide a description on how mandatory referrals will be provided;
b) At what point would Clients be referred to other resources for medium or long-term
assistance, which is not part of this program? Give examples of when that estimate
might be exceeded and how such occurrences would be administered;
c) List the medical services to which Clients may be referred, showing the complete
name of each, in order of preference, and the condition to be treated. Provide
information on waiting lists and delays in receiving attention, and how your firm would
handle these, if at all.
(v)
Communication
a) What are the guaranteed timelines of response to inquiries and requests from Clients,
and of assessment and referral?
b) Is the first contact with a messaging service or an employee qualified to assess and
refer the Client?
c) How will anonymity be preserved?
d) Identify the priority that would be given to the Clients in both normal and abnormal
times, for example in the event of a wide-area emergency’
e) Provide four examples only of a Client booklet or pamphlet, wallet card and workplace
poster;
f) What are your procedures to investigate and resolve complaints of harassment,
intimidation or improper or unethical conduct? What is your dispute resolution
process?
g) How do your counsellors have their debriefing needs met?
h) How does your organization handle real or perceived conflicts of interest?
i) Aside from English, list what other languages are available to Clients.
(vi)
Other Services
a) Describe your ability to provide services described in Schedule A, section 2.3 Other
Services.
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b) Describe any additional services that would be available to the City or the Clients, and
their cost, if any; and
c) Describe services which would assist Clients without cost to the City.
information on waiting lists, if any, and how these are handled if at all.
(vii)
Provide
Implementation Plan/Transition Plan
a) Describe your transition plans should you be the successful Consultant.
b) Provide information on how you have done it in the past – especially with non-network
providers?
(viii)
Seminars and Workshops
a) Provide a list of workshops / seminar topics you are able to provide:
Examples:
i. Workplace dynamics,
ii. Recognizing workplace stresses,
iii. Coping with stress,
iv. Nutrition for a healthy lifestyle,
v. Heart and stroke awareness,
vi. Coping with aging parents,
vii. Parenting,
(ix)
Training
a) Provide the necessary management / steward training to promote knowledge of
EFAP, including rollout and marketing of program initially and on an ongoing basis.
i. Various training programs available;
ii. Location of training facilities;
iii. Ability to provide training at ICBC locations; and
iv. Training methodology.
(x)
Reporting
a) Outline the Client records that are created and how Client confidentiality is maintained
and guaranteed. Describe the type of reporting of program utilization that will be
provided, and supply a sample. What would be the frequency of reporting?
b) Provide a list of the significant reports that you would anticipate providing the City’s
management team, including their relationship to project milestones and the method
of delivery (electronic, paper, e-mail, other);
(xi)
Quality Assurance Plan
a) Describe your company’s quality control and quality assurance program. How are
practitioners supervised in order to protect the City’s and Clients’ interests? Provide
the Code of Ethics signed by practitioners, assessors and referral agents;
Employee & Family Assistance Program, RFP #1220-030-2015-030
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b) Provide a description of the standards to be met by the Proponent in providing the
Services;
c) Provide your proposed quality assurance plan for the provision of Services. The plan
will outline the scope of activities, level of resources needed and related
responsibilities.
d) Suggest the frequency and method of third-party audits of the program and your
service.
(xii)
Business Continuity Plan
a) Describe your emergency and business continuity plan in general terms. What
contingency plans would you have in place to continue providing service to Clients if a
specified individual is not available?
(xiii)
Value Added
Describe any value added services and/or options that your company provides or is
willing to provide to your Clients that are not specifically covered in this RFP.
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SCHEDULE C-4 - PROPONENT’S TECHNICAL PROPOSAL (TIME SCHEDULE)
Proponents should provide an estimated schedule, with major item descriptions and time
indicating a commitment to perform the Services within the time specified (use the spaces
provided and/or attach additional pages, if necessary).
MILESTONE DATES __________________________________
ACTIVITY
1
2
Employee & Family Assistance Program, RFP #1220-030-2015-030
3
4
SCHEDULE
5
6
7
8
9
10
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SCHEDULE C-5 - PROPONENT’S FINANCIAL PROPOSAL
Proponents should set out in their Proposal, the proposed fee structure (excluding GST), and the basis
of calculation (use the spaces provided and/or attach additional pages, if necessary).
Provide your Proposal on the method that your firm would expect to be compensated for your services
during the term. The methods of compensation include but are not limited to: a fee for service, an
hourly rate, a cost per full-time employee and volunteer firefighter.
1.
What is your estimate of the annual charges that you would expect the provision of these
services to generate? Provide general statistics from other, similar organizations to substantiate
your estimate:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
2.
Outline briefly, proposed methods to provide quality service while minimizing costs to the City.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
3.
Describe how you would handle variations from the estimated compensation:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
____________________________________________________________________________________________________
______________________________________________________________________________________
4.
Provide estimated percentages of referrals to medical or other services available at no cost to
the City, and the basis for the estimate. Special charges/costs that other employers experience:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
5.
Alternate methods of remuneration may be proposed.
____________________________________________________________________________________________________
______________________________________________________________________________________
____________________________________________________________________________________________________
______________________________________________________________________________________
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Additional Expenses:
The proposed Contract attached as Schedule "B" to the RFP provides that expenses are to be included
within the fee, other than the expenses listed in the Contract as disbursements. Details of
disbursements are to be shown in the chart above. Please indicate any expenses that would be
payable in addition to the proposed fee and proposed disbursements set out above:
Payment Terms:
A cash discount of ______% will be allowed if account is paid within _______ days, or the _________
day of the month following, or net 30 days, on a best effort basis.
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