SCHEDULE B - QUOTATION
RFQ Title: Water Meter Maintenance Services
RFQ No:
1220-040-2015-053
CONTRACTOR
Legal Name:
Address:
Phone:
Fax:
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: purchasing@surrey.ca
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
4.
Requested Departure(s) / Alternative(s)
The City requires that the successful Contractor have the following in place before
providing the Goods and Services:
(a)
(b)
(c)
(d)
(e)
(f)
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 ___________________________;
Prime Contractor qualified coordinator is Name: _______________
and Contact Number: _________________________;
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;
City of Surrey or Intermunicipal Business License: Number ________________;
If the Contractor’s Goods and Services are subject to GST, the Contractor’s GST
Number is _____________________________________; and
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.
Destination
Freight
Prepaid
Payment Terms:
Ship Via:
A cash discount of ____% will be allowed if invoices are paid
within ___ days, or the ___ day of the month following, or net
30 days, on a best effort basis.
PART A: PROGRAM WORK
1. Locate and Expose Buried Meter Box
Quantity
20
Water Meter Maintenance Services RFQ #1220-040-2015-053
Price 1
$
Price 2
$
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
Replace damaged wiring
25
Price 1
Price 2
$
$
5. Lid Replacement
Chamber Size
Quantity
Price 1
Price 2
300x500
15
$
$
425x750
10
$
$
600x900
10
$
$
6. Mount Pitpad
Type
Mount into Existing lid
Mount with new lid
Chamber Size
Quantity
Price 1
Price 2
300x500
35
$
$
425x750
35
$
$
600x900
10
$
$
300x500
35
$
$
425x750
35
$
$
600x900
10
$
$
7. Replace Remote Receptacle
Type
Wall Mounted
Pit Pad
Manufacturer
Quantity
Sensus
25
$
$
ABB
25
$
$
Neptune
25
$
$
Sensus
25
$
$
ABB
25
$
$
Neptune
25
$
$
Water Meter Maintenance Services RFQ #1220-040-2015-053
Price 1
Price 2
Page 59 of 86
8. Relocate Remote Receptacle
Type
Wall Mounted
Pit Pad
Manufacturer
Quantity
Price 1
Price 2
Sensus
5
$
$
ABB
5
$
$
Neptune
5
$
$
Sensus
5
$
$
ABB
5
$
$
Neptune
5
$
$
9. Pre-Cast Concrete Meter Box
Type
300mmx500mm
425mmx750mm
600mmx900mm
Size
Quantity
Price 1
Price 2
150mm
10
$
$
300mm
4
$
$
150mm
10
$
$
200mm
5
$
$
250mm
5
$
$
150mm
4
$
$
200mm
3
$
$
250mm
2
$
$
Size
Quantity
300mm
10
$
$
300mm EXT
4
$
$
457mm
5
$
$
300mm
10
$
$
300mm EXT
5
$
$
457mm
5
$
$
9 a. HDPE Composite Meter Box
Type
Price 1
Price 2
Raven Products
280mm x457mm
430mm x760mm
Water Meter Maintenance Services RFQ #1220-040-2015-053
Page 60 of 86
10. Replace Register
Type
Sensus SRII Meter
Neptune T-10 Meter
Elster C-700 Meter
Sensus Omni Meter
Meter Size (mm)
Quantity
Price 1
Price 2
16x19
50
$
$
19
30
$
$
25
10
$
$
38
10
$
$
50
10
$
$
16x19
40
$
$
19
30
$
$
25
10
$
$
38
10
$
$
50
10
$
$
16x19
40
$
$
19
30
$
$
25
10
$
$
38
10
$
$
50
10
$
$
50
10
$
$
75
5
$
$
100
5
$
$
Neptune TT, HPT
Water Meter Maintenance Services RFQ #1220-040-2015-053
Page 61 of 86
11. Replace Water Meter
Type
Meter Size (mm)
Quantity
16x19
6
$
$
19
5
$
$
25
4
$
$
38
3
$
$
50
2
$
$
16x19
6
$
$
19
5
$
$
25
4
$
$
38
3
$
$
50
2
$
$
16x19
6
$
$
19
5
$
$
25
4
$
$
38
3
$
$
50
2
$
$
Sensus iPERL
19
150
$
$
SensusOmni Meter
50
50
$
$
Sensus SRII Meter
Neptune T-10 Meter
Elster C-700 Meter
Water Meter Maintenance Services RFQ #1220-040-2015-053
Price 1
Price 2
Page 62 of 86
12. Replace Meter Setter
Type
Height (mm)
Quantity
Price 1
Price 2
Ford 70 Series
16mm x19mm
178
5
$
$
228
5
$
$
305
20
$
$
381
1
$
$
458
1
$
$
533
1
$
$
610
1
$
$
203
1
$
$
305
10
$
$
381
1
$
$
457
1
$
$
533
1
$
$
610
1
$
$
254
1
$
$
305
5
$
$
381
1
$
$
458
1
$
$
534
1
$
$
610
1
$
$
305
1
$
$
381
1
$
$
457
1
$
$
533
1
$
$
610
1
$
$
686
1
$
$
305
1
$
$
381
1
$
$
457
1
$
$
533
1
$
$
610
1
$
$
19mm
25mm
38mm
50mm
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
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
50
1
$
$
19
10
$
$
0m – 1.5m (depth)
Sensus SRII Meter
Neptune T-10 Meter
Elster C-700 Meter
Sensus Omni Meter
Sensus iPERL Meter
Water Meter Maintenance Services RFQ #1220-040-2015-053
Page 64 of 86
13a.
1.6 m – 2.0 m (depth)
Type
Sensus SRII Meter
Neptune T-10 Meter
Elster C-700 Meter
Sensus Omni Meter
Sensus iPERL Meter
Meter Size (mm)
Quantity
Price 1
Price 2
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
50
1
$
$
19
5
$
$
Meter Size (mm)
Quantity
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
13b.
2.1 m – 2.5 m (depth)
Type
Sensus SRII Meter
Neptune T-10 Meter
Water Meter Maintenance Services RFQ #1220-040-2015-053
Price 1
Price 2
Page 65 of 86
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
Sensus Omni Meter
50
1
$
$
Sensus iPERL Meter
19
5
$
$
Elster C-700 Meter
14. No Maintenance Site Visit
Quantity
50
Price 1
$
15. Replace Measuring Chamber
Type
Sensus SR
Neptune T-10
Elster C-700
Size
Quantity
16x19
10
$
$
19
10
$
$
25
1
$
$
38
1
$
$
50
1
$
$
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
Water Meter Maintenance Services RFQ #1220-040-2015-053
Price 1
Price 2
Page 66 of 86
16. Replace Meter Base Plates
Type
Sensus SR
Neptune T-10
Elster C-700
Size
Quantity
Price 1
Price 2
16x19
10
$
$
19
1
$
$
25
1
$
$
16x19
5
$
$
19
1
$
$
25
1
$
$
16x19
5
$
$
19
1
$
$
25
1
$
$
Size
Quantity
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
17. Service Pipe Leak Repairs
Type
Price 1
Price 2
Polyethylene Tubing
Copper Tubing
Galvanized Iron Tubing
Water Meter Maintenance Services RFQ #1220-040-2015-053
Page 67 of 86
18. Meter Testing
Type
Field Testing
Bench Testing
Size
Quantity
Price
16x19
1
$
19
1
$
25
1
$
38
1
$
50
1
$
16x19
1
$
19
1
$
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
$
Water Meter Maintenance Services RFQ #1220-040-2015-053
Price 2
$
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
10
Price 1
$
Price 2
$
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
Replace damaged wiring
Water Meter Maintenance Services RFQ #1220-040-2015-053
Quantity
15
Price 1
$
Price 2
$
Page 69 of 86
5. Lid Replacement
Chamber Size
Quantity
Price 1
Price 2
300x500
10
$
$
425x750
10
$
$
600x900
10
$
$
6. Mount Pitpad
Type
Mount into Existing lid
Mount with new lid
Chamber Size
Quantity
Price 1
Price 2
300x500
10
$
$
425x750
10
$
$
600x900
5
$
$
300x500
10
$
$
425x750
10
$
$
600x900
5
$
$
7. Replace Remote Receptacle
Type
Wall Mounted
Pit Pad
Manufacturer
Quantity
Price 1
Price 2
Sensus
10
$
$
ABB
10
$
$
Neptune
10
$
$
Sensus
10
$
$
ABB
10
$
$
Neptune
10
$
$
8. Relocate Remote Receptacle
Type
Wall Mounted
Pit Pad
Manufacturer
Quantity
Sensus
5
$
$
ABB
5
$
$
Neptune
5
$
$
Sensus
5
$
$
ABB
5
$
$
Neptune
5
$
$
Water Meter Maintenance Services RFQ #1220-040-2015-053
Price 1
Price 2
Page 70 of 86
9. Pre-Cast Concrete Meter Box Risers
Type
300mmx500mm
425mmx750mm
600mmx900mm
Size
Quantity
Price 1
Price 2
150mm
5
$
$
300mm
4
$
$
150mm
5
$
$
200mm
5
$
$
250mm
5
$
$
150mm
4
$
$
200mm
3
$
$
250mm
2
$
$
Size
Quantity
300mm
5
$
$
300mm EXT
4
$
$
457mm
5
$
$
300mm
5
$
$
300mm EXT
5
$
$
457mm
5
$
$
9 a. HDPE Composite Meter Box
Type
Price 1
Price 2
Raven Products
280mm x457mm
430mm x760mm
10. Replace Register
Type
Sensus SRII Meter
Neptune T-10 Meter
Meter Size (mm)
Quantity
Price 1
Price 2
16x19
30
$
$
19
25
$
$
25
10
$
$
38
10
$
$
50
10
$
$
16x19
30
$
$
19
25
$
$
25
10
$
$
38
10
$
$
50
10
$
$
Water Meter Maintenance Services RFQ #1220-040-2015-053
Page 71 of 86
Elster C-700 Meter
Sensus Omni Meter
16x19
30
$
$
19
25
$
$
25
10
$
$
38
10
$
$
50
10
$
$
50
10
$
$
75
5
$
$
100
5
$
$
Neptune TT, HPT
11. Replace Water Meter
Type
Sensus SRII Meter
Neptune T-10 Meter
Elster C-700 Meter
Sensus iPERL
SensusOmni Meter
Meter Size (mm)
Quantity
16x19
6
$
$
19
5
$
$
25
4
$
$
38
3
$
$
50
2
$
$
16x19
6
$
$
19
5
$
$
25
4
$
$
38
3
$
$
50
2
$
$
16x19
6
$
$
19
5
$
$
25
4
$
$
38
3
$
$
50
2
$
$
19
50
$
$
50
10
$
$
Water Meter Maintenance Services RFQ #1220-040-2015-053
Price 1
Price 2
Page 72 of 86
12. Replace Meter Setter
Type
Height (mm)
Quantity
Price 1
Price 2
Ford 70 Series
16mm x19mm
178
1
$
$
228
1
$
$
305
5
$
$
381
1
$
$
458
1
$
$
533
1
$
$
610
1
$
$
203
1
$
$
305
5
$
$
381
1
$
$
457
1
$
$
533
1
$
$
610
1
$
$
254
1
$
$
305
5
$
$
381
1
$
$
458
1
$
$
534
1
$
$
610
1
$
$
305
1
$
$
381
1
$
$
457
1
$
$
533
1
$
$
610
1
$
$
686
1
$
$
305
1
$
$
381
1
$
$
457
1
$
$
533
1
$
$
610
1
$
$
19mm
25mm
38mm
50mm
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
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
50
1
$
$
19
10
$
$
0m – 1.5m (depth)
Sensus SRII Meter
Neptune T-10 Meter
Elster C-700 Meter
Sensus Omni Meter
Sensus iPERL Meter
Water Meter Maintenance Services RFQ #1220-040-2015-053
Page 74 of 86
13a.
1.6 m – 2.0 m (depth)
Type
Sensus SRII Meter
Neptune T-10 Meter
Elster C-700 Meter
Sensus Omni Meter
Sensus iPERL Meter
Meter Size (mm)
Quantity
Price 1
Price 2
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
50
1
$
$
19
5
$
$
Meter Size (mm)
Quantity
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
13b.
2.1 m – 2.5 m (depth)
Type
Sensus SRII Meter
Neptune T-10 Meter
Water Meter Maintenance Services RFQ #1220-040-2015-053
Price 1
Price 2
Page 75 of 86
Elster C-700 Meter
Sensus Omni Meter
Sensus iPERL Meter
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
50
1
$
$
19
5
$
$
14. No Maintenance Site Visit
Quantity
20
Price 1
$
15. Replace Measuring Chamber
Type
Sensus SR
Neptune T-10
Elster C-700
Size
Quantity
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
16x19
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
Water Meter Maintenance Services RFQ #1220-040-2015-053
Price 1
Price 2
Page 76 of 86
16. Replace Meter Base Plates
Type
Sensus SR
Neptune T-10
Elster C-700
Size
Quantity
Price 1
Price 2
16x19
10
$
$
19
1
$
$
25
1
$
$
16x19
5
$
$
19
1
$
$
25
1
$
$
16x19
5
$
$
19
1
$
$
25
1
$
$
Size
Quantity
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
19
1
$
$
25
1
$
$
38
1
$
$
50
1
$
$
17. Service Pipe Leak Repairs
Type
Price 1
Price 2
Polyethylene Tubing
Copper Tubing
Galvanized Iron Tubing
Water Meter Maintenance Services RFQ #1220-040-2015-053
Page 77 of 86
18. Meter Testing
Type
Field Testing
Bench Testing
Size
Quantity
Price
16x19
1
$
19
1
$
25
1
$
38
1
$
50
1
$
16x19
1
$
19
1
$
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
$
Water Meter Maintenance Services RFQ #1220-040-2015-053
Price 2
$
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
1
2
3
4
SCHEDULE
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):
Description Of
Goods & Services
Sub-Contractors &
Material Suppliers Names
Years Of
Working With
Contractor
Telephone Number
And Email
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
No.
1
2
3
4
5
16.
Equipment Description
Engine Tier
Designation
 Tier 0 or
 Tier 0 or
 Tier 0 or
 Tier 0 or
 Tier 0 or
Engine Registration
Number as Issued by
Metro Vancouver
 Tier 1
 Tier 1
 Tier 1
 Tier 1
 Tier 1
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)
Water Meter Maintenance Services RFQ #1220-040-2015-053
________________________________________
(Print Name and Position of Authorized Signatory)
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)
(b)
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
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)
(b)
ensure that the activities of employers, workers and other persons at the workplace relating to
occupational health and safety are coordinated, and
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: ___________________
Name of Person in Charge of Project:
Fax: _____________________________________
_____________________________________________________
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.
Water Meter Maintenance Services RFQ #1220-040-2015-053
Page 84 of 86
Attachment # 3
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.
Water Meter Maintenance Services RFQ #1220-040-2015-053
Page 85 of 86
Attachment # 4
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:
Water Meter Maintenance Services RFQ #1220-040-2015-053
Date:
Page 86 of 86