APPLICATION FORMSGENERAL CONTRACTOR

PRE-QUALIFICATION PROCESS

FOR

GATEWAY COMMUNITY HEALTH CENTRE

41 McClellan StreetTweed, Ontario

A Microsoft Word version of these forms that can be completed electronically is available at

http://jacksonbrown.on.ca/resources/

PROJECTADDITION TO AND REDEVELOPMENT OF EXISTING BUILDING TO ACCOMODATE

THE GATEWAY COMMUNITY HEALTH CENTRE EXPANSIONAT 41 MCCLELLAN STREET, TWEED ONTARIO

OWNERGATEWAY COMMUNITY HEALTH CENTRE (GCHC)

ANTICIPATED TENDERING DATEJULY 2017

ANTICIPATED CONSTRUCTION STARTOCTOBER 2017

ANTICIPATED CONSTRUCTION COMPLETIONSPRING 2019

(All dates tentative – to be confirmed)

DEADLINE FOR SUBMISSIONSRevised as follows per Addendum No. 4

By Hand: No later than 11:00 AM, TUESDAY MAY 2 2017

Package to be submitted in a sealed opaque envelope, three copies, plus a USB key containing an electronic copy of the

submission collated in pdf formatAddressed to:

Shoalts and Zaback Architects LimitedAtt: Cam Burns

4 Cataraqui Street, Suite 206, Kingston, Ontario K7K 1Z7

CONTACTKIM MÉNARD

JACKSON-BROWN ASSOCIATES INC.PHONE: (613) 293-9784

E-MAIL: km@jacksonbrown.on.ca

ISSUEDAPRIL 25, 2017. Rev. 2

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Purpose and Intent

The purpose of this process is to select a list of construction general contracting firms qualified to tender the addition to and renovation of the existing one storey building to create a new community health centre located at 41 McClellan Street, Tweed, Ontario.

The proposed development will result in approximately 10,000+ square feet of new space for primary care services and programs. The existing building of approximately 10,000.s.f + will be renovated to accommodate GCHC programming needs. The current estimated construction cost is $6 million ($6,000,000).

Throughout the expansion, the GCHC will remain open to the public, relocating to the new expanded space on completion to allow for the renovation to the existing building to commence. Immediate renovations will include: Interior renovations to the current main (clinical) floor Interior renovations to the lower level area for community programs, staff offices and a staff room Major alterations include a new HVAC system and connecting roofs between the expansion and

the existing building New mechanical systems for the clinical and community floors must be in compliance with Ministry

of Health requirements and CSA Z8000. New electrical panels with an updated and expanded new service

This process will pre-qualify firms to be selected to bid on the proposed expansion and renovation project. The intent is to ensure, through a full and fair public pre-qualification process, that firms bidding on the project can perform the work in a satisfactory and timely manner in compliance with Ontario Ministry of Health and Long Term Care requirements, with all due diligence and competency, and with minimal risk of contractor default.

Outline of Process

An ad-hoc tender pre-qualification selection group known as the Working Group will be established from within the existing project team. This group will comprise the project manager, the architect and representatives from Gateway Community Health Centre.

Stage 1: Responses will be checked for compliance with the mandatory criteria. Stage 2: Responses will be assessed based on the non-mandatory criteria. Stage 3: Reference checks will be conducted. References will be asked to comment on the

general contractor’s performance on past projects with respect to contract administration, site supervision, quality of work, site safety policy, attitude, cooperation, and compliance with the schedule. The working group reserves the right to contact references other than those provided by the respondent. Please ensure contact information for references is current. Provide updated contact information where the primary reference may no longer be working with the original project team but is still willing to provide a reference with respect to the former project.

Stage 4: Respondents may, at the discretion of the Working Group, be invited to attend an interview. Interviews will take place in Tweed at a location and date to be confirmed.

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Stage 5: Respondents will be notified of their status on the list of pre-qualified general contracting firms following reference checks and interviews (as needed).

Stage 6: Pre-qualified general contracting firms will be invited to proceed to tender on preparation of the tender documents by the architect.

Evaluation

The following are mandatory criteria. Responses not clearly demonstrating that the requirements have been met, will receive no further consideration during the evaluation process. Exceptions to rigid enforcement of the submission requirements will only be considered if less than six complete and qualified submissions are received, in which case other submissions may, at the discretion of the working group, receive further consideration. Incomplete submissions that receive further consideration under these circumstances will be prioritized based firstly on the extent of their compliance to the submission requirements and secondly on their relative ranking in relation to the selection criteria. Submissions lacking CCDC 11, evidence of bonding or a banking letter shall not be considered under any circumstances.

Application form and relevant documentation Completed CCDC 11 2016 with Copyright Seal Bonding: Satisfactory evidence of ability to obtain satisfactory bonding, as follows:

o 10% bid bondo 100% performance bondo 50% labour and 50% materials bond

Credit: Current bank letter, specific to this project, indicating adequate financial capacity to undertake this project. A letter including specific references to credit limits will be preferred over letters which only provide a subjective rating.

Responses meeting the mandatory requirements will be further assessed against the following non-mandatory criteria via a scoring system. A respondent not reaching the minimum score in a given category (if applicable) will receive no further consideration during the qualifications review.

Criteria Basis Points available

Points required

Organization and history Application section 4-5

50 36

Health and safety Application section 6-8

20 15

Project documentation Application section 9

20 15

Relevant experience of proposed office and site personnel

CCDC-11, resumes

24 18

Firm’s/entity’s experience in successfully completing projects, including similar or related projects

CCDC-11, references

24 18

Current project load CCDC-11 12 9Total points available 150 111

Respondents may, at the discretion of the Working Group, be invited to attend an interview. The interview will provide an opportunity for the Working Group to receive clarification of the documentation submitted by the respondent and assist them in the evaluation of the submitted response in regards to the mandatory and non-mandatory criteria.

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APPLICATION FORM FOR CONTRACTOR PRE-QUALIFICATION

This sheet should be completed and submitted as page one of your submission package.

Instructions for completing form:This form can be completed electronically. Click on the appropriate check boxes to select your response. Enter text in the grey shaded area following the question.

Submission: Three (3) hard copies and one electronic copy on USB key in an opaque envelope referencing “Gateway Community Health Centre Redevelopment, Tweed, ON” on Tuesday, May 2 2017 no later than 11:00:00 AM EST to be delivered to:

SHOALTS AND ZABACK ARCHITECTS LTD, Att: Cam Burns

4 Cataraqui Street, Suite 206, Kingston, ON K7K 1Z7

APPLICATION FORM FOR CONTRACTOR PRE-QUALIFICATION INTERNAL USE ONLY

Mandatory requirements

☐ Application form

☐ Completed CCDC 11-2016 Contractors Qualification Statement with Seal

☐ Proof of bonding capacity

☐ Bank letter indicating adequate financial capacity

Supporting documentation

☐ Curriculum vitae of potential project managers and site supervisors

☐ Certificate of Insurance from nationally recognized insurance company

☐ Client or consultant references complete with telephone numbers

☐ Additional information (indicate below):

     

     

     

Direct any inquiries regarding the submission in writing to:Kim Ménard

Senior Project ManagerJackson-Brown Associates Inc.

km@jacksonbrown.on.ca

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APPLICATION FORM FOR CONTRACTOR PRE-QUALIFICATION INTERNAL USE ONLY

1. Company identification

1.1 Company name:      

1.2 Contact name and title:      

1.3 Mailing address:      

1.4 Telephone:      

1.5 Fax:      

1.6 E-mail:      

2. Form of business

☐Sole owner☐Partnership☐Corporation

3. Officers

Name Title Years with company

      Owner(s)      

      President/CEO      

      Health/safety supervisor      

4. Organization

4.1 Type of construction work in which your company specializes:     

4.2 (a) Work you normally perform with your own forces:     

(b) Work you normally sub-contract to others:     

4.3 What is the maximum dollar volume completed and invoiced over the past two years: In aggregate:       On a single project:      

4.4 Do you have a base in the Tweed area?☐Yes – Indicate location:      ☐No – Describe how you will manage communications and decision-making:     

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APPLICATION FORM FOR CONTRACTOR PRE-QUALIFICATION INTERNAL USE ONLY

4.5 Provide a short list of projects (maximum 6) that demonstrate your experience with Ontario Ministry of Health and Long Term Care requirements, your ability to provide documents electronically through commonly used software, document control and management, wood frame construction, infection control requirements, working in buildings with existing tenants, and/or retrofitting existing buildings.

Name Details Location                                                                                                      

Attach a separate list if insufficient space above.

4.6 Do you have a quality control program?☐Yes – Describe:      ☐No

5. History and experience

5.1 How many years has your organization been in the business as a general contractor under its current name?      

5.2 How many years’ experience in construction work has your organization had: As a construction manager?       As a prime general contractor?       As a sub-contractor?      

5.3 Are there any judgments, claims or suits pending or outstanding against your company?☐Yes – Explain:      ☐No

5.4 Have you received any regulatory (MOL, MOE, etc.) orders and/orprosecutions in the last 3 years?☐Yes – Explain:      ☐No

5.5 Are you involved in organizations such as the Construction Safety Association or Industrial Accident Prevention Association?☐Yes – Describe:      ☐No

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APPLICATION FORM FOR CONTRACTOR PRE-QUALIFICATION INTERNAL USE ONLY

5.6 Does your organization have experience working within the constraints, requirements and payment schedules typical of projects funded directly or indirectly by the Government of Ontario or more specifically the Ministry of Health and Long Term Care?☐Yes – Explain:      ☐No

5.7 Are you a current member of the Ontario General Contractors Association?☐Yes☐No

Name other relevant general contractors’ association where you are a member:     

5.8 Do you have experience with CSA Class ‘C’ standards?☐Yes – describe briefly      ☐No

5.9 Do you have experience with infection control requirements for healthcare facilities?☐Yes – describe briefly      ☐No

5.10

Do you have experience with wood frame construction?☐Yes – describe briefly      ☐No

5.11

Do you have experience retrofitting existing buildings?☐Yes – describe briefly      ☐No

5.12

Do you have experience with construction in buildings with tenants remaining in place during construction?☐Yes – describe briefly      ☐No

5.13

Have you worked on projects where a commissioning agent was retained by the Owner/Client independent of the project team to oversee commissioning of building systems, and systems delivery?☐Yes – Provide names of recently completed projects where a commissioning agent was involved:      Attach a separate list if insufficient space above.☐No

5.14

Briefly list what steps you would take when learning of an unknown site condition:     Attach a separate list if insufficient space above.

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APPLICATION FORM FOR CONTRACTOR PRE-QUALIFICATION INTERNAL USE ONLY

5.15

Briefly describe what steps you would take to address subcontractor claims and request for changes for additional cost:     Attach a separate list if insufficient space above.

6. Health and safety performance

6.1 Can you provide proof of current Workplace Safety and Insurance? (Certificate of Clearance)☐Yes – Attach documentation☐No

6.2 Has any employee of your company suffered a work related fatal accident or “critical injury” as defined by the Ontario Occupational Health and Safety Act?☐Yes☐No

6.3 Has your company ever been subjected to a WSIB Audit?☐Yes – What was your final score?      ☐No

6.4 Have you ever voluntarily participated in a WSIB Workwell audit?☐Yes☐No

7. Health and safety program and procedures

7.1 Do you have a written health and safety policy?☐Yes – Provide a copy of the Health and Safety policy statement from your corporate Health and Safety program. A complete copy will be required at the time of contract award.☐No

7.2 Do you have a written health and safety program?☐Yes☐No

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APPLICATION FORM FOR CONTRACTOR PRE-QUALIFICATION INTERNAL USE ONLY

7.3 Does the program include work practices and procedures such as:a. Equipment Lockout and Tag-out (LOTO) ☐Yes ☐Nob. Confined space entry ☐Yes ☐Noc. Fall protection ☐Yes ☐Nod. Personal protective equipment ☐Yes ☐Noe. Portable electrical / power tools ☐Yes ☐Nof. Vehicle safety ☐Yes ☐Nog. Compressed gas cylinders ☐Yes ☐Noh. Electrical equipment grounding assurance ☐Yes ☐Noi. Powered industrial vehicles (cranes,

forklifts, etc.)☐Yes ☐No

j. Housekeeping ☐Yes ☐Nok. Accident / incident reporting ☐Yes ☐Nol. Unsafe condition reporting ☐Yes ☐Nom. Tailgate meetings ☐Yes ☐Non. Emergency preparedness, including

evacuation plan☐Yes ☐No

o. Waste disposal ☐Yes ☐Nop. Respiratory protection ☐Yes ☐Noq. Designated substance management ☐Yes ☐No

8. Health and safety of subcontractors

8.1 Do you use safety and health performance criteria in the selection ofsubcontractors?☐Yes☐No

8.2 Do you ask your subcontractors if they have a written health and safety program?☐Yes☐No

8.3 Do you include your subcontractors in:a. Health and safety orientation ☐Yes ☐Nob. Health and safety meetings ☐Yes ☐Noc. Inspections ☐Yes ☐Nod. Audits ☐Yes ☐No

8.4 Do you have a policy for the termination of contracts of subcontractors who do not comply with the Occupational Health and Safety Act and Regulations and/or company rules and policies?☐Yes – Include a sample of the document used for safety notice violations on site.☐No

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APPLICATION FORM FOR CONTRACTOR PRE-QUALIFICATION INTERNAL USE ONLY

9. Additional project documentation

9.1 List software used by your firm for project management (e.g. Microsoft Excel, Microsoft Project, Timberline, R-Forms, Microsoft Word, etc.)     

9.2 Provide one page samples of the following project documentation. Please ensure you remove any identifying or confidential information related to the project or trade.☐Any standardized forms of trade agreement with terms and conditions☐Cash flow projection for a project☐Project value breakdown used for progress billing submissions☐Change order log☐Change order quotation with supporting documents☐Subtrade meeting minutes☐Gantt chart schedule that would typically be used on the project☐Shop drawing log

10. Additional comments

10.1

If you have any additional relevant or pertinent information you wish to provide, please enter it below.     

I agree that the above information is true and correct to the best of my knowledge. I understand that background documentation may be requested by the Working Group. By submitting this application package, I consent to references being contacted as part of the evaluation process.

Name: (please print or type)      

Title:      

Signature:

Date:      

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