SCHEDULE C – FORM OF PROPOSAL
RFP Project Title:
Insurance Broker Services
RFP Reference No.:
#1220-030-2011-042
Name of Proponent:
Contact Person and Title:
Business Address:
Telephone:
Fax:
E-Mail Address:
TO:
City Representative:
Kam Grewal, CMA,BBA, Internal Audit Manager, Acting Purchasing and Accounts
Payable Manager
City of Surrey, City Operations Works Yard, Purchasing Section, 1st Floor
Address:
6645-148 Street, Surrey, B.C. Canada V3S 3C7
Telephone:
604-590-7274
Fax:
604-599-0956
Email 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 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.
[NON-WEBSITE OPTION: 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, 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 (Schedule); and
Schedule C-5 – Proponent’s Financial Proposal.
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3.0
I/We confirm that this proposal is accurate and true to best of my/our knowledge.
4.0
I/We confirm that, if I/we am/are awarded the agreement, I/we will at all times be the “prime consultant” 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
consultant”, 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 of _________________________, 2012.
I/We have the authority to bind the Proponent.
_______________________________________
_______________________________________
(Name of Proponent)
(Name of Proponent)
_______________________________________
_______________________________________
(Signature of Authorized Signatory)
(Signature of Authorized Signatory)
_______________________________________
_______________________________________
(Print Name and Position of Authorized
(Print Name and Position of Authorized
Signatory)
Signatory)
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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
2.
Requested Departure(s) / Alternative(s)
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 Consultant qualified coordinator is Name: __________________ and Contact Number:
______________;
c)
Insurance coverage for the amounts required in the proposed Contract 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, see Consultants Certificate of Insurance;
d)
City of Surrey business license;
e)
If the Proponent's Goods and Services are subject to HST, the Proponent's HST Number is
____________________________________; and
f)
If the Proponent 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
3.
Requested Departure(s) / Alternative(s)
I/We offer the following alternates to improve the Services described in the RFP (list, if any):
Section
RFP #1220-030-2011-042
Requested Departure(s) / Alternative(s)
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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.
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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 branches, background, stability, structure of the Proponent;
(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 servicing 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;
(vi)
Proponent’s financial strength (with evidence such as financial statements, bank references);
(vii)
[Optional – other criteria]
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(viii)
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:
Project Name:
Responsibility:
_______________________________________________________________________
Dates:
Project Name:
Responsibility:
_______________________________________________________________________
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(ix)
Proponents should provide the following information on the background and experience of all subconsultants 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
YEARS OF
TELEPHONE NUMBER
WORKING
AND EMAIL
WITH
CONSULTANT
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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)
a narrative that illustrates an understanding of the City’s requirements and Services;
(ii)
a description of the general approach and methodology that the Proponent would take in
performing the Services including specifications and requirements;
(iii)
a narrative that illustrates how the Proponent will complete the scope of Services, manage the
Services, and accomplish required objectives within the City’s schedule;
(iv)
a description of the standards to be met by the Proponent in providing the Services;
(v)
[Optional – other criteria]
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
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SCHEDULE C-4 - PROPONENT’S TECHNICAL PROPOSAL (SCHEDULE)
Proponents should provide an estimated schedule, with major item descriptions and time indicating a
commitment to perform the Contract within the time specified (use the spaces provided and/or attach
additional pages, if necessary).
MILESTONE DATES __________________________________
ACTIVITY
SCHEDULE
1
RFP #1220-030-2011-042
2
3
4
5
6
7
8
9
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10
SCHEDULE C-5 - PROPONENT’S FINANCIAL PROPOSAL
Indicate the Proponent’s proposed fee (excluding HST), and the basis of calculation (use the spaces provided and/or
attach additional pages, if necessary) as follows (as applicable):
(i)
monthly fee;
(ii)
hourly rates for all team members if payment is to be made on an hourly basis; or
(iii)
lump sum fee.
TABLE A
Item
No.
BROKERAGE SERVICES
Description
i
Property, Liability, Crime and Boiler & Machinery
policies only
ii
Fleet Automobile Liability
iii
Construction Insurance Placements
Annual Amount
Payment Terms:
Fee is due and payable within 30 days of receipt of invoice or at contract inception, whichever is later.
SPECIAL PROVISIONS:
1.
Only the Fee is in addition to the net premium paid for the Coverages, and it is payable upon
receipt of invoices at the inception of this agreement.
2.
Commissions are paid by insurers from the premiums the City pays and are earned by the
Contractor for the entire policy period at the time the Contractor places the policy with the City.
3.
If any insurer requires the Contractor to receive commissions in regard to any of the Coverages,
which are inconsistent with the provisions above, the Contractor will promptly notify the City of
such commissions and seek the City’s written agreement to receive them.
4.
The Contractors compensation may be revised if the City requests a change in the Coverages
and/or Services during the Term of this agreement and the Contractor enters into a written
agreement documenting any change in Coverages, Services and compensation.
5.
In some cases the use of a wholesale broker may be beneficial to the City. The Contractor will
not directly or indirectly knowingly place or renew the City’s insurance business through a
wholesale broker unless the Contractor firstly discloses in writing to the City as follows:
(a)
any interest the Contractor has in, or any contractual agreements, the Contractor has
with the wholesale broker; and,
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(b)
any alternatives to using the wholesale broker; and,
(c)
any compensation the Contractor or corporate parents, subsidiaries or affiliates will
receive as a result;
and, obtain the City’s consent to do so. If the Contractor expects to recommend the use of a
wholesale broker, any compensation the Contractor or their corporate parents, subsidiaries or
affiliates will receive as a result is also included in the total compensation provided for above in
this Appendix 2.
6.
Other parties such as underwriting managers or managing general agents may also earn and
retain usual and customary commissions for their roles in providing insurance products and
services to the City. If any such parties are corporate parents, subsidiaries or affiliates of the
Contractor, any compensation the Contractor or their corporate parents, subsidiaries or affiliates
will receive is included in the total compensation provided for above in this Appendix 2.
7.
The City may choose to use a premium finance company, property appraiser, structure
settlement firm or other similar service provider in connection with the insurance coverages the
Contractor will place for the City. If the City elects to use a service provider from which the
Contractor or their corporate parents, subsidiaries or affiliates will receive any compensation
directly or indirectly relating to the services the City purchases from the provider, the Contractor
will disclose additional information regarding that compensation to the City before the City makes
a final decision to use the service provider.
8.
In the ordinary course of business the Contractor may also receive and retain interest on
premiums the City pays from the date the Contractor receives the funds until the Contractor pays
them to the insurers or intermediaries.
9.
As an insurance intermediary, the Contractor will act on behalf of the City. However, the
Contractor or their corporate parents, subsidiaries or affiliates may provide services to insurers for
some insurance products. These services may include (a) acting as a managing general agent,
program manager or in other similar capacities which give the Contractor binding authority
enabling the Contractor to accept business on the City’s behalf and immediately provide
coverage for a risk: (b) arranging lineslips or similar facilities which enable an insurer to bind
business for itself and other insurers; or (c) managing lineslips for insurers. Contracts with these
insurers may grant the Contractor rights or create certain obligations regarding the marketing of
insurance products provided by the insurers.
10.
The Contractor may place the City insurance business under such a managing agent’s
agreement, binding authority, lineslips or similar facility when we reasonably consider that these
match the City’s insurance requirements/instructions. When the Contractor intends to do so, the
Contractor will inform the City and disclose the contractual arrangements the Contractor has with
the insurer.
11.
The Contractor will also provide reinsurance brokerage services to insurers with which City
coverage is placed pursuant to separate agreements with those insurers. The Contractor may be
compensated by the insurers for these services in addition to any compensation the Contractor
may receive for placement of City insurance coverages.
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12.
Prices on the Services specified herein are exclusive of all federal, provincial and local sales, use,
excise, receipts, gross income and other similar taxes and governmental charges. Any such
taxes or charges upon the Services provided hereunder, now imposed or hereafter becoming
effective during the term of this agreement, shall be added to the price herein provided and paid
by the City unless, in lieu thereof, the City provide the Contractor with a valid tax exemption
certificate acceptable to the Contractor.
13.
Premium/Handling of Funds
The City agrees to provide immediately available funds for payment of premiums by the payment
dates specified in the insurance policies, invoices or other payment documents. Failure to pay
premium on time may prevent coverage from incepting or result in cancellation of coverage by the
insurer.
The Contractor will handle any premiums the City pays through the Contractor and any funds
which the Contractor receives from insurers or intermediaries for payment or return to you in
accordance with the requirements and restrictions of applicable provincial and federal insurance
laws and regulations and unclaimed property laws. In some cases the Contractor may transfer
the City’s funds directly to insurers. In other case the Contractor may be required to transfer the
City funds to third parties such as wholesale brokers, excess and surplus lines brokers, or
managing general agents for carrying out transactions for you.
14.
15.
If the Contractor terminates this agreement for convenience prior to the expiration of the Term,
the Contractor will be deemed to have fully earned and be entitled to a pro rata portion of the Fee,
calculated from the start of the Fee period through to the date of termination. If the City
terminates this agreement for convenience prior to the expiration of the Term, the Contractor will
be deemed to have fully earned and be entitled to a portion of the fee as set forth in the following
table:
(a)
during the first six months:
75%
(b)
after six months
100%
The Contractor’s obligation to render the Services under this Agreement ceases at the end of the
Term or on the effective date of termination, whichever is sooner. The Contractor will take
reasonable steps to assist in the orderly transition of matters to the City or to a new contractor,
whichever the City designates. Claims and premium or other adjustments may arise after
expiration or termination. Such items are normally handled by the Contractor at the time of claim
or adjustment arises. The Contractor will, process all remaining deposit premium instalments on
the policy(ies) in effect at the time of change.
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TABLE B
Item
No.
ADDITIONAL SERVICES
Description
Estimated Qty. of
Hours
Hourly Rate
Total Amount
[Excluding GST]
CONSULTING SERVICES
i
iii
Contract Review and General Risk
Management Advice.
Risk Assessment and Loss
Prevention Reports
Claims Administration
iv
Retention Analysis Study
v
Third Party Risk Analysis
vi
Third Party Certificate Review
vii
Environmental Studies, Mergers &
Acquisitions, Disaster Recover
Planning, Consolidated Holistic All
Risk Model
viii
Earthquake Modelling – MPL
ii
BUNDLED SERVICES
Transaction Services (only includes i.
of Brokerage Services in Appendix 2)
i
N.B. ICBC and Construction
insurance as per ii and iii of
Brokerage Services in Appendix 2).
Consulting Services (only includes i;
ii; and iii of Consulting Services as
shown above).
ii
Note: i of Consulting Services
includes no more than 3 risk
assessment/loss per contract term –
any additional inspections will be
charged at $___ per location.
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Additional Expenses:
All disbursements are included in the above fees options. It should be noted that ancillary coverages
such as automobile liability through ICBC would be subject to standard commission rates as published by
ICBC (copy attached) and Project specific construction insurance policies will be subject to insurer-paid
commissions which will be disclosed at the quotation stage and negotiated with the City as required.
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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