Capital Grant and Transitional Funding

Transcription

1 Number 6 Capital Grant and Transitinal Funding A Guide Sheet May 2010 Versin 1.2

2 Purpse A set f Nurse Practitiner-Led Clinic implementatin guide sheets is being made available t yur grup t assist in the develpment f yur Nurse Practitiner-Led Clinic. This is dcument Number 6, titled Capital Grant and Transitinal Funding A Guide Sheet. Its appendix sectin (Appendix A thrugh Appendix L) features additinal backgrund infrmatin and sample dcuments fr review. Objective f Capital and Transitinal Funding This guide sheet is meant t assist thse establishing a Nurse Practitiner-Led Clinic in their cmmunity and submitting requests fr capital grant funding and transitinal funding (i.e. start-up funds) fr ne-time cst items. Apprpriate wrk space, furnishings and equipment are key enablers fr Nurse Practitiner-Led Clinics. Capital grant funding prvides supprt fr facility renvatins. Transitinal funding is fr ne-time start-up csts incurred t establish and implement a clinic. Such ne-time csts include equipment, furnishings, and infrmatin technlgy. Capital grant funding (btained thrugh a Capital Grant Agreement) and ne-time funding (thrugh the Nurse Practitiner-Led Clinic Operatinal Agreement) are intended t supplement, nt replace, existing funding surces frm cmmunity and prvider partners. Funding assistance will be prvided n a ne-time basis, which is separate and distinct frm nging perating funds. NP-Led Clinic Funding Principles Nurse Practitiner-Led Clinic funding requests are subject t the fllwing three principles: 1. Prprtinality Funding is prprtinal t the eligible number f apprved Nurse Practitiner-Led Clinic members; 2. Eligibility Funding is limited t apprved eligible items; and 3. Reasnableness Apprved eligible items are funded within the apprved benchmark. What is Eligible? Nurse Practitiner-Led Clinic applicants apprved by the Ministry f Health and Lng-Term Care (the ministry) t prceed with implementing a clinic are eligible fr: Up t 100% (minus any cntributins) f clinical and ffice equipment, and furnishings required t prvide patient services 1 ; 1 Supprt fr clinical and ffice supplies will be cnsidered under peratinal funding. 2

3 Up t 100% (minus any cntributins) f facility imprvements t accmmdate Nurse Practitiner-Led Clinic members; and Up t 100% (minus any cntributins) f ne-time expenses directly related t the prvisin f apprved equipment, furnishings, and facility imprvement expenditures (e.g. prime cnsultant s fees). Supprted by a business case, the ministry will cnsider funding: Up t 100% f facility imprvement csts, where there is limited r n pprtunity fr lcal cntributins. What is nt Eligible? The fllwing items are nt eligible fr capital grant funding: Clinical and ffice equipment, furnishings, facility renvatins and related expenses that are cvered by private (mnetary r in-kind) r public (e.g. ther gvernment prgram) cntributins; Purchase r cnstructin f real prperty, such as land r buildings/facilities 2 ; Infrmatin technlgy funded thrugh the Physician IT Prgram, r ther items as specified in dcument Number 8, titled Infrmatin Technlgy A Guide Sheet; New r replacement furnishings, facility imprvements, r equipment exclusively fr prviders currently receiving funding fr these items thrugh ther funding arrangements; Residence mving csts; Interir design cnsultants as an architect/prime cnsultant; Exterir furnishings fr residents/clients (e.g. lawn chairs, benches); Demlitin f existing buildings; Cntingency budgets; Financing charges; Gardens, wrks f art and decratins; Cnstructin f parking facilities; Cnstructin management; Administratin fees (e.g. levied n taxes, utilities, and/r repairs); and Any expenditure nt authrized by the ministry. 2 In exceptinal cases, where the Nurse Practitiner-Led Clinic chses t purchase r cnstruct/expand a facility, the ministry will cnsider prviding a ntinal peridic payment equal t the market value f an equivalent facility. 3

4 The list abve is nt exhaustive. Fr questins n specific items nt nted, please cnsult with yur ministry cntact. Applicatin Submissin Applicatins fr ne-time item funding are t be submitted as part f the Business Plan and Operatinal Plan, after apprval f the Nurse Practitiner-Led Clinic s human resurce. Capital grant funding requests are submitted using the Phase 1 Checklist and may be submitted prir t submitting the Business Plan and Operatinal Plan. Applicatin Requirements Facility Imprvements In rder t receive cnsideratin fr facility imprvement funding, eligible applicants must submit a tw-phased prpsal, fllwing apprval f Nurse Practitiner-Led Clinic members 3. Phase 1 Submissin f cmpleted Facility Imprvement Phase 1 Checklist (see Appendix A fr sample and full details), which includes such infrmatin as: The name and cntact infrmatin f the applicant and, if applicable, the legal entity r spnsring rganizatin that will receive funding and wh will be accuntable t the ministry fr the prper use f the funds thrugh a signed legal agreement; A frmal assessment/descriptin/schematics f existing facilities and space; Facility space requirements fr each facility in the Nurse Practitiner-Led Clinic per apprved prvider including, but nt limited t: Prpsed changes t flr plans, in square feet r square metres, as per the Space Planning Guidelines (see Appendix B fr sample); Area that is t be used by the Nurse Practitiner-Led Clinic; Useful life f the facility imprvements depending n the scpe f renvatins (e.g. existing facility r new facility space); Number f wrk statins in the receptin area; Average number f peple waiting in the waiting rm at peak hurs; and Estimated cst per square ft/square metre. 3 Inter-prfessinal Health Prviders and administrative prfessinals. 4

5 Phase 2 Upn ministry cmmunicatin f the apprved space, yur Nurse Practitiner-Led Clinic is t submit a cmpleted Facility Imprvement Phase 2 Checklist (see Appendix C fr sample), which includes such infrmatin as: Key assumptins used t determine facility space requirements; A descriptin f the accessibility f the prpsed site, identifying all pssible barriers; Prpsed facility layut (flr plans) f the ttal space t be imprved (including apprved Phase 1 space) shwing space and rm allcatin, and their dimensins; Scpe f renvatins, including upgrades t building systems mechanical, electrical, architectural, etc.; A cmpleted Lease Agreement Infrmatin Schedule; A cpy f the lease agreement if requested by the ministry; Prf that the applicant, wh is als the ccupant, has permissin [frm the landlrd and tenants (if applicable)] t make the prpsed changes; Identificatin f facility wnership and if any are Nurse Practitiner-Led Clinic members r gverning bdy members; Details f plans t share the prpsed facility space with ther prviders r rganizatins that are nt part f the prpsed Nurse Practitiner-Led Clinic; identify the affected facility space area and cst-sharing arrangements and ratinale; Availability r expected surce f funds; and A descriptin f financial and/r in-kind supprt such as cntributins frm spnsrs, cmmunity partners r landlrd that will be used t ffset ne-time expenditures and any cnditins attached t each cntributin. Where the ttal facility imprvement cst estimate is under $10,000, the Nurse Practitiner-Led Clinic must fllw the requirements as set ut in the Cmpetitive Bidding Requirements (see Appendix D). Three cmpetitive qutes are required. The fllwing clause (r a variatin) shuld be included in the request fr qutes frm three general cntractrs/vendrs: "The lwest r any bid will nt necessarily be accepted." The Nurse Practitiner-Led Clinic must prvide the ministry the fllwing infrmatin cncerning the selected cntractr s/vendr s qute: Scpe f wrk (e.g. painting walls, decnstructin, rehabilitatin, plumbing); A detailed breakdwn f cst estimates (e.g. cst f labur, materials); Apprximate start date and cmpletin date; Psitive assessment/review f selected qute by architectural cnsultant/engineer; and 5

6 Nurse Practitiner-Led Clinic gverning bdy s mtin indicating their acceptance f a qute. The Nurse Practitiner-Led Clinic must keep the three cmpetitive qutes n file and prvide them t the ministry if requested. Where ttal facility imprvement cst estimates exceed $10,000, the Nurse Practitiner-Led Clinic must fllw the requirements as set ut in the Cmpetitive Bidding Requirements and must prvide the ministry with: Cnfirmatin by a qualified prfessinal that all prpsed changes are technically feasible and cmply with applicable cdes, statutes and rdinances; A signed letter t the ministry that the cntractr meets the qualifying precnditins as set ut in the Cmpetitive Bidding Requirements sectin; A preliminary cst estimate that includes a breakdwn f csts fr each element f cnstructin; A schedule update that indicates the estimated start and cmpletin dates fr tender f the prject; The cmplete bidding/tendering package; A detailed analysis f the bids, the recmmended bid, and the ratinale fr endrsing it; and Cpies f the three lwest bids. A signed and cmpleted Final Estimate f Cst (see Appendix H fr sample) and cmpletin timeline; The Nurse Practitiner-Led Clinic gverning bdy s mtin indicating their acceptance f the bid; A signed and cmpleted Final Capital Cst frm (see Appendix I fr sample), upn cmpletin f the facility imprvement, but befre the final payments have been released; A signed and cmpleted Final Submissin f Disbursements (see Appendix J fr sample), after all payments relating t the facility imprvement have been made; Prime cnsultant/apprpriate prfessinal s appraisal f the impact f the facility imprvement n the value f the prperty fr facility imprvements that are between $10,000 and $100,000, if deemed necessary by the ministry; and An appraisal by a member f the Accredited Appraiser Canadian Institute that states the effect f the facility imprvements n the value f the prperty, if the facility imprvements are ver $100,000 r if deemed necessary by the ministry. Clinical and Office Equipment and Furnishings In rder t receive funding cnsideratin fr clinical and ffice equipment and furnishings, eligible applicants must submit as part f the Business Plan and Operatinal Plan an itemized list (including type, quantity and cst per item, and ttal price as per Table 1, see sample next page) f prpsed 6

7 eligible expenditures per rm, fllwing apprval f bth Nurse Practitiner-Led Clinic members 4 and clinic space. Table 1 Sample Equipment and Furnishings Request Furnishing Prvider Ttal wh will Type f and Clinical Existing Cmmunity Other Ministry use the Rm ² Quantity Equipment - cst per Partner Surces f Funding One-time furnishing unit Cntributins Funding Request csts A B C D E F G ABI machine $0.00 Ambulatry Bld Pressure Devices $0.00 Audiscpe $0.00 Autclave, Autmatic $0.00 Replacement Plicy A Nurse Practitiner-Led Clinic seeking apprval fr funding f replacement equipment 5 shall prvide a ratinale and the apprpriate dcumentatin (receipts, warranty). Equipment purchased with ministry funding is eligible t be replaced if it passes the fllwing criteria: The ministry and the Nurse Practitiner-Led Clinic have sught and cannt find alternative avenues fr extending the life f the equipment; AND The warranty n the equipment has expired and/r is nt applicable; AND The equipment can n lnger functin due t extensive wear; AND/OR The vendr (r manufacturer) is terminating the prduct, and essential cmplimentary equipment (e.g. Operating System, cmplimentary sftware, ther hardware, medical 4 Inter-prfessinal Health Prviders and administrative prfessinals 5 Equipment means ffice furnishings, clinical and infrmatin technlgy equipment. 7

8 equipment) can n lnger supprt the ld equipment (e.g. accmmdating sftware releases/upgrades and/r t enable access t new and/r imprved electrnic resurces). Redeplyment Plicy As replacement equipment is apprved and purchased, the Nurse Practitiner-Led Clinic is t redeply the ld equipment. Accessibility In June 2005, the prvince passed the Accessibility fr Ontarians with Disabilities Act, 2005, which launched a 20-year prcess t make Ontari mre accessible in bth the public and private sectrs t persns with disabilities. As Nurse Practitiner-Led Clinics prceed t start-up (recruiting, designing, equipping, and furnishing their space) all Nurse Practitiner-Led Clinics shuld ensure accessibility frm patient and emplyee perspectives. Nurse Practitiner-Led Clinics are asked t review an upcming dcument title, Accessibility Planning Infrmatin and Resurces: Addressing the Needs f Ontarians with Disabilities A Guide Sheet that is being develped t assist clinics t becme familiar with accessibility issues related t persns with disabilities. It will prvide general infrmatin n the changing legislative framewrk addressing Ontarians with disabilities, resurce links and further cntact infrmatin. It is up t yur architect and any space-planning advisr t be fully aware f gvernment requirements related t addressing the needs f Ontarians with disabilities. Funding Prcess A prtin f yur funding may be prvided in advance, nce the applicatin has been apprved, based n lcal and justifiable needs. The balance f apprved funds will be flwed at a frequency determined in an agreement between the ministry and Nurse Practitiner-Led Clinic. Cnflict f Interest Capital grant funding applicants shall ensure that the capital grant funding is used in a manner that precludes a cnflict f interest by any persn assciated with the funding request in whatever capacity. Fr clarity, a cnflict f interest includes a situatin in which a persn assciated with the request r any member f his r her family is able t benefit financially frm his r her invlvement. Terms and Cnditins Capital grant funding applicants must be willing t sign a grant funding agreement that will specify the purpse f the funding, ttal amunt t be prvided, restrictins n the use f the funding, and final deliverables. Signatries must have the authrity t bind the rganizatin. 8

9 Where t Get Mre Infrmatin All Nurse Practitiner-Led Clinics wh have received cnditinal apprval t prceed can btain mre infrmatin frm their assigned ministry cntact. This cntact will be yur guide t assist yu t wrk thrugh the details and ptins f establishing yur Nurse Practitiner-Led Clinic. If yu have nt yet been assigned a ministry cntact, please refer t the ministry s website at: fr cntact infrmatin. 9

10 Appendix A Sample Facility Imprvement Phase 1 Checklist Facility Imprvement Phase 1 Checklist and Instructins This is Phase 1 f 2 phases t review and apprve Nurse Practitiner-Led Clinic facility imprvement requests. Phase 1 includes the basic requirements necessary t cnduct initial apprval fr facility imprvements. Please prvide the infrmatin pertaining t yur facility imprvement request as per the checklist belw, including Addenda I and II. Once the Phase 1 Checklist is cmpleted, please send it t yur ministry cntact. Facility Imprvement Requirements Checklist Phase 1 Requirements The name and cntact infrmatin fr the applicant and, if applicable, the legal entity r spnsring rganizatin that will receive funding and be accuntable t the ministry fr the prper use f the funds thrugh a signed legal agreement. A frmal assessment/descriptin/schematics f prpsed facilities and space Prvide facility space requirements fr each apprved prvider (as per Addenda I and II [next tw pages]) including, but nt limited t: Ttal space required itemized in Addendum II Thumbnail sketch f the clinic in the prpsed space Number f wrk statins in the receptin area A time-line fr cnstructin Estimated cst per square ft/metre fr the renvatins Landlrd details f the lease Grss and Net rental csts Check (/) Cmments Ntes: 1. If there is insufficient infrmatin t cmplete the checklist, please prvide it within a week f yur request. 2. Prvide a different checklist fr each lcatin/satellite. 3. Ensure that space requirements are entered based n the apprved health and administrative staff. 10

11 Appendix A (cntinued) Addendum I: Apprved Staff Psitin Apprved Staff (FTEs) Inter-prfessinal Staff Nurse Practitiners Registered Nurses Scial wrker Dietician Other (list) Administratin Admin Lead Receptinist Other persnnel (list) Ttal 0 Nte: In the table abve, detail the apprved staffing fr yur Nurse Practitiner-Led Clinic 11

12 Appendix A (cntinued) Addendum II Facility Space Requirements Apprved FTEs*/ Size in sq Space Functin f Descriptin f Number feet / sq c-lcating rms/space rms/space metres practitiners [Clumn 1] [Clumn 2] [Clumn 3] [Clumn 4] Physicians Physician Office 0.00 Examinatin rm 0.00 Inter-prfessinal Staff Nurse Practitiner Office 0.00 Examinatin rm Nurse Practitiner ffice/clinical space 0.00 examinatin rm Registered nurse ffice/clinical space IHP (list) ffice/clinical space IHP (list) ffice/clinical space 0.00 Administrative Staff Admin Lead Office ther (list) 0.00 Cmmn functins receptin strage waiting area meeting rm staff rm medical recrds staff washrm public washrm 0.00 Sub-ttal net space Grss factr (e.g. 125%) % % Ttal Space Requirements (Grss factr X net space) *Please ensure that the space requirements abve are cmpleted based n the apprved health and administrative staff. Instructins: 1. Enter the psitin f Nurse Practitiner-Led Clinic member; 2. Enter the type f rm required fr that Nurse Practitiner-Led Clinic member; 3. Enter the number f rms required fr that Nurse Practitiner-Led Clinic member; 4. Enter the size f the rm in square feet/square metres; and 5. Add rws as required. 12

13 Appendix B Space Planning Guidelines The purpse f this dcument is t facilitate the planning and design f yur Nurse Practitiner-Led Clinic facilities. Listing Of Rms Table 1.1 lists mst f the rms nrmally fund in primary health care facilities, which accmmdate the users (primary care prviders, allied health prfessinals, administratin, supprt staff, clients/patients, visiting cnsultants, and thers), the functinal and peratinal requirements f the Nurse Practitiner-Led Clinic ffice, and the prgrams and services that are prvided. The Table cites the flr areas f rms (in square feet/square metres). These flr areas reflect the functinal requirements fr rms in current primary care health facilities and are generally cnsistent with the flr area standards, including barrier free accessibility standards, established in the Ontari Building Cde. In sme rms (e.g. waiting rm, meeting rms, etc.), the flr areas may depend upn the number f users f the rms. Table 1.1 prvides an incremental flr area per persn, which can be used t calculate the net flr area required t accmmdate the ultimate number f users f the rms. Rms Offices Table 1.1 List f Rms Flr Area in square feet (SF) square metres (SM) Ntes Standard Offices - Private 110 (10.2) Basic ffice fr the facility Standard Offices - Shared Special Purpse Offices Exam rms Administrative Lead (Business Manager) 150 (13.9) 125 (11.6) Dietitian 125 (11.6) Scial Wrker 110 (10.2) Other Cmbined ffice exam rm 125 (11.6) General purpse exam rm 90 (8.36) The standard ffice fr use by tw persns; this flr area increases by 75 SF fr each additinal prvider and/r allied health prfessinal Examples f flr areas fr rms required t accmmdate special functins; see Sectin 3.0 Basic ffice with separate r adjacent cunselling rm; 125 SF as cmbined ffice cunselling rm As required Adjacent t, in prximity f, r intercnnected with a care prvider s ffice 13

14 Rms Flr Area in square feet (SF) square metres (SM) Special purpse exam rm 125 (11.6) Minr treatment rm 125 (11.6) Ntes Service rms Med rm/clean utility 100 (9.3) Strage f medicatins, drug samples and ther clean supplies Siled utility rm 100 (9.3) Garbage strage, recycling waste, dispsal f expired medicatins, sharps, etc. Lab 110 (10.2) Supprt rms Janitr's clset 50 (4.64) Cmputer server rm 80 (7.43) Receptin area 110 (10.2) Basic flr area; flr area increases by 50 SF fr each additinal wrk statin. (e.g. fr a medical secretary) Wrkrm 150 (13.9) Medical recrds rm 200 (18.58) Waiting rm 300 (27.87) Flr area fr the rm t accmmdate shelving fr apprximately 3,000 charts; the actual size f the rm may vary depending n the amunt f shelving, circulatin, and ther functins (e.g. wrk statin) determined in the detailed design f the facility Minimum flr area fr typical waiting rm with a peak perid ccupancy f 15 persns; flr area increases by 15 SF fr each additinal adult persn Multi-purpse cunselling rm Small meeting rms Large meeting rms 125 (11.6) (18.58) (27.87) (27.87) (46.4) Minimum flr area fr ccupancy up t 6 persns; flr area increases by 12 SF fr each additinal persn Grups f up t 15 persns at 20 SF per persn Grups f 15 t 25 persns at 20 SF per persn Staff lunch rm 300 (27.87) Minimum flr area; rm fr ccupancy up t 12 staff; flr area increases by 12 SF fr each additinal persn Strage Nn-medical supplies and equipment (xygen) As required 14

15 Rms Archives Washrms Flr Area in square feet (SF) square metres (SM) Ntes As required Public washrms male 125 (11.6) Public washrms female 125 (11.6) Staff washrm 45 (4.2) Wheelchair accessible rm Clinical washrm 45 (4.2) Wheelchair accessible rm Calculatin f Flr Areas Net and Grss NET FLOOR AREAS The net flr area f each rm listed in the table (as square feet r square metres) is the prduct f the interir rm dimensins (length x width). Sme variance ver r under the flr areas cited may be quite apprpriate depending n wh uses the rm and hw it is used (fr example, a standard exam rm may need t be smewhat larger in flr area t permit barrier free access t special purpse examinatin table). Wide variatins in sme r all f the flr areas, hwever, shuld be explained. GROSS FLOOR AREAS There are rms, spaces and elements in a facility (e.g. strage areas, interir crridrs, partitins, structural elements [clumns], mechanical and electrical service spaces, interir stairs, and functinal areas such as the entrance vestibule, fyer, laundry, etc.) that may nt be included in the rm list but need t be cnsidered t establish the cnstructin cst f the prject. The sum f the flr areas identified in the rm list and the flr area f the ther rms and spaces cmprise the ttal grss flr area. The grss flr area is used t calculate the cst f renvatin r cnstructin f a prject and, in turn, will establish the capital grant funding required. The ttal grss flr area may nt be measurable at the beginning f the space planning and design prcess (elements such as crridrs, duct spaces, structure, etc., are nt specifically defined until the design f the space is smewhat advanced). The grss flr area can be calculated by multiplying the ttal net flr area (the sum f the net flr areas f all rms) by a number called a grssing factr. The grssing factr is the rati f the ttal net t ttal grss flr area. It is a measurement f the efficiency f the flr plan fr use and is generally nt used fr leasing purpses. The efficiency f a flr plan is an expressin f hw much space is dedicated t habitable use (e.g. ffices as ppsed t crridrs). A Nurse Practitiner-Led Clinic facility will vary in efficiency (even if the spaces are well-designed), depending n whether it: 15

16 Occupies a prtin f a flr in a cmmercial ffice building r retail space (e.g. shpping mall); Occupies the whle flr r flrs f a cmmercial ffice building; r Is a self-cntained facility in its wn building. The fllwing table illustrates the degree f efficiency by facility type. Table 2.1 Flr Area Efficiency Flr Area Efficiency Grssing Factr Grssing Elements t be included in the grss flr area Prtin f a flr in an existing cmmercial ffice building r retail space (e.g. in shpping mall) Ttal flr f cmmercial ffice building Self-cntained building High 80% Mst f the flr area in this type f facility wuld be habitable; Limited amunt f nn-habitable spaces; nt included fr grssing calculatin: elevatr shaft, elevatr lbby, main building crridr, stairs, exterir walls Mderate 75% A prtin f the flr area is required fr crridrs, exiting, stairs, service areas, etc., nt identified in the list f rms Lw 60% This type f facility cntains a significant amunt f nn-habitable space such as crridrs, exits, service areas, etc Interir partitins Interir crridrs Service spaces 1.33 Interir partitins Interir crridrs Service spaces, stairs, elevatrs, lbby 1.67 Interir partitins Interir crridrs Service areas, stairs, elevatrs, lbby, exterir walls The grssing factr might range frm 1.25 t 1.67 x net flr area. Changes in the size f the peratin may necessitate increases in the number f primary facilities (rms required t accmmdate additinal staff and prgrams). Additinal ancillary and supprt facilities may be required t cmplement (augment) the expansin f the primary facilities (e.g. additinal waiting rm area, additinal medical recrds space). Ancillary and supprt facilities can be added in accrdance with the flr area increments identified in Table

17 Rms and Functins The fllwing sectin describes sme f the use and ccupancy characteristics f the rms identified in Table 1.1 and sme f the required furniture and equipment that influence rm size. STANDARD OFFICES PRIVATE The private ffice is a standard fr mst staff including the administratin staff, primary care prviders, allied health prfessinals, and supprt staff. It may be used by individuals fr their wn prfessinal wrk purpses dcumentatin, reprt writing, phne calling, meetings with clleagues, etc. The ffice may cntain: a desk (r wrk statin), ffice chair, visitr s chair(s), bkshelf, filing cabinet, credenza, cmputer return, etc. STANDARD OFFICES SHARED Offices may be prvided fr individual staff members but shared n a scheduled basis r prvided with flr area fr tw r mre persns t accmmdate the apprpriate number f wrk statins r desks, chairs, visitrs chairs, bkshelves, filing cabinet(s), credenzas, etc. The flr area f 75 square feet per persn shuld include the space required fr each wrk statin as well as the flr area required fr cmmn space circulatin, visitrs chairs, filing cabinets, shelving units, etc. SPECIAL PURPOSE OFFICES Special purpse ffices are included t accmmdate the special functinal requirements f the staff and users f the rms. Sme f these ffices are included in Table 1.1. An Administrative Lead s (Business Manager s) ffice may be larger than the standard ffice in rder t accmmdate a meeting area with table and chairs r a sitting area with sfa and cffee table, etc. Inter-prfessinal Health Prviders, such as dietitians, scial wrkers, and thers may require additinal flr area t prvide cunselling r ther services within their private ffices. COMBINED OFFICE EXAM ROOMS Accrding t their requirements, primary care prviders may prefer their ffices and exam rms cmbined t accmmdate their administrative wrk, dcumentatin, reprting, phne calling, meetings with clleagues, etc., as well as patient examinatins and treatment. The rm shuld cntain: a wrk statin r desk, chair, visitrs chairs, bkshelf, filing cabinet, exam table, stl, sink, base cabinet, upper cupbards, privacy curtain, etc. GENERAL PURPOSE EXAM ROOMS General purpse exam rms fr primary care prviders t examine and treat patients can be in prximity t, adjacent t r intercnnected with a prvider s ffice. The rms may be assigned fr the private use f individuals r may be shared by tw r mre primary care prviders. All exam rms shuld cntain: an exam table, stl, sink, base cabinet, upper cupbards, and equipment related t the prcedures undertaken. SPECIAL PURPOSE EXAM ROOMS Special purpse exam rms may be prvided t accmmdate the special needs f clients/patients fr wheelchair accessibility, special furniture, etc. LARGE EXAM ROOM The rm can be shared and used n a scheduled basis fr examinatins, treatment f clients/patients wh are accmpanied by family members, translatrs, thers fr supprt. 17

18 MINOR TREATMENT ROOM The rm can be used n an as-needed r scheduled basis fr minr surgical prcedures, sterile dressing applicatins, pre-exam measurements (bld pressure, height and weight), patient/client frm filling, etc. Service Rms MED. ROOM/CLEAN UTILITY The rm fr the strage f medicatins, drug samples and ther clean supplies may cntain cunter tp, base cabinets, and upper cupbards. Cupbards shuld be lckable. SOILED UTILITY ROOM The rm fr the temprary strage f garbage, recycling, dispsal f expired medicatins, sharps, etc., may cntain bins, a sink, cuntertp r shelving. LAB The rm is suggested fr thse Nurse Practitiner-Led Clinics in which bld and urine specimens are cllected and held fr pick-up by persnnel frm medical testing cmpanies. The rm may cntain a sink, cuntertp, shelving, a small fridge, etc. The med. rm and lab may be cmbined, with care taken t ensure infectin cntrl measures. Supprt Rms JANITOR S CLOSET A rm(s) may be prvided fr the strage f cleaning equipment f in-huse r cntract cleaning services especially in larger facilities. The rm(s) generally includes mp sinks, shelving fr paper prducts, rm fr strage f recycling bins, strage fr flr cleaning equipment (mps, vacuum cleaners, etc.). COMPUTER SERVER ROOM A rm may be prvided fr server equipment, cmputer repairs, and servicing. Its design shuld be cnfirmed in cnsultatin with IT specialists. RECEPTION AREA The receptin area prvided fr a receptinist t greet patients/clients, t prvide infrmatin and directins, and t perfrm clerical functins and/r fr staff (e.g. medical secretary t perfrm a variety f clerical and clinical functins) shuld be lcated t permit gd visual surveillance f the peple entering and leaving the facility, and sitting in the waiting area. It shuld be designed t prvide gd accessibility fr all persns t staff fr infrmatin, assistance, and directins, t ensure privacy and cnfidentiality in patient/client and staff interactins, and t establish a cmfrtable envirnment in which staff can perfrm their wrk. The area shuld be designed with: a receptin cunter (a sectin f which will facilitate barrier free access t persns in wheelchairs), a desk r built-in wrk statin with drawers fr the receptinist and each additinal staff member, ffice chair, filing cabinet, and ther equipment (e.g. switchbard, fax machine, etc.) as required. WORKROOM A wrkrm may be prvided fr the use f receptin/clerical staff t supprt the functins f administratin, fr strage f paper stck, ffice supplies, ffice files, fr the peratin f the 18

19 phtcpy machine, fax machine, fr mail service, etc. The rm shuld cntain shelving, a wrk table and strage cabinets, as required. The size f the wrk rm is determined by the functins assciated with the Nurse Practitiner-Led Clinic peratin and nt dependent upn the size f the patient ppulatin. MEDICAL RECORDS ROOM This rm culd be prvided t accmmdate active patient charts and ther files requiring a secure facility. Active patient charts may be lcated in the receptin area as desired by the Nurse Practitiner-Led Clinic with an adjustment in the size f the receptin area t accmmdate the required shelving. The size f the rm is dependent n the patient/client lad and n the shelving system emplyed. The design f the rm shuld be carefully cnsidered. It may need t accmmdate an expansin f the strage f charts and files in the near future. On the ther hand, it may nt ultimately be required as a self-cntained strage rm with the intrductin f electrnic charting. Other uses may be cnsidered fr this rm in the future. WAITING ROOM Patients, clients, and visitrs will use this area during ffice hurs while waiting fr scheduled appintments. The rm shuld be lcated t permit staff t mnitr the patients/clients and shuld be designed t preserve staff privacy and cnfidentiality. The size f this area is determined by the number f users, the type f practice prpsed, and the services prvided by the Nurse Practitiner-Led Clinic (and nt by the number f full time equivalents in the peratin). The rm will cntain the apprpriate seating (including bariatric chairs as required), and may prvide directinal infrmatin, displays and resurce material, a health prmtin cmputer kisk, r kisks, etc. CHILDREN S AREA A children s area may be prvided depending n the nature f the Nurse Practitiner-Led Clinic peratin adjacent t and in additin t the waiting rm. This is a distinct area (with its wn furniture, accessible height-apprpriate shelving fr tys, etc.) adjacent t and visible frm the main waiting area fr parental supervisin and cntrl. MULTI-PURPOSE COUNSELLING (GROUP) ROOM The rm used by allied health prfessinals (psychlgists, scial wrkers, dietitians, etc.) fr grup cunselling, self-help grups, family cunselling culd cntain: cmfrtable chairs, sfas, cffee and end tables, table lamps, etc. SMALL AND LARGE MEETING ROOMS The meeting rms shuld cntain the tables and chairs required fr grup functins and shuld permit a variety f arrangements f furniture apprpriate t the activities cnducted in the rms. STAFF LUNCH ROOM This staff rm fr scializing, infrmal cmmunicatin and wrk breaks shuld cntain: kitchenette facilities sink, cuntertp, cupbards, small appliances tables, chairs and/r cmfrtable seating. 19

20 STORAGE This rm may be prvided fr the strage f archival files and recrds, equipment and medical and nn-medical supplies, prgram materials. WASHROOMS Public Male and Female The size f the rms will be determined by the ccupant lad in the building. The flr areas f the washrms identified in Table 1.1 can accmmdate: in the male washrm 2 tilets (ne wheelchair accessible), ne urinal, and 2 sinks recessed in vanity cuntertps; and in the female washrm 3 tilets, (ne wheelchair accessible), and 3 sinks recessed in vanity cuntertps. Staff Staff and clinical washrms are identified as wheelchair accessible, single use rms with ne tilet and ne sink. 20

21 Appendix C Sample Facility Imprvement Phase 2 Checklist This dcument is a cntrl sheet fr Nurse Practitiner-Led Clinic t ensure that facility imprvement requests fulfill the ministry requirements. Instructins This is Phase 2 f tw phases t review and apprve Nurse Practitiner-Led Clinic facility imprvement requests. Please prvide the infrmatin pertaining t the facility imprvement request as per the Checklist belw. As each piece f infrmatin is attained, please send it t yur ministry cntact. Facility Imprvement Requirements Checklist Phase 2 Requirements Key assumptins and ratinale fr facility imprvements after space apprval Descriptin f accessibility f the prpsed site, identifying all pssible barriers Prpsed facility layut (flr plans) f ttal space t be imprved (including apprved Phase 1 space) shwing space & rm allcatin & their dimensins Scpe f renvatins, including upgrades t building systems mechanical, electrical, architectural, etc. A cmpleted Lease Agreement Infrmatin Schedule (see Appendix K fr sample) If requested by the ministry, a cpy f the lease agreement Prf that applicant, wh is als the ccupant, has permissin [f landlrd and tenants (if applicable)] t make prpsed changes using prpsed cntractr Identificatin f facility wnership and if any are team members, including gverning bdy members Details f plans t share prpsed facility space with ther prviders r rganizatins that are nt part f prpsed team; identify affected facility space area and cst-sharing arrangements and ratinale Availability r expected surce f funds A descriptin f financial and/r in-kind supprt such as cntributins frm spnsrs, cmmunity partners r landlrd that will be used t ffset ne-time expenditures and any cnditins attached t each cntributin Where ttal facility imprvement cst estimate under $10,000, the Nurse Practitiner-Led Clinic must fllw the requirements as set ut in the Cmpetitive Bidding Requirements sectin in the Capital Grant and Transitinal 21 Check (/) Cmments

22 Requirements Facility Imprvement Requirements Checklist Phase 2 Check (/) Cmments Funding A Guide Sheet, and must prvide the ministry the fllwing infrmatin cncerning the selected cntractr s/vendr s qute: Scpe f wrk (e.g. painting walls, decnstructin, rehabilitatin, plumbing); A detailed breakdwn f cst estimates (e.g. cst f labur, materials); Apprximate start date and cmpletin date; Psitive assessment/review f selected qute by architectural cnsultant/engineer; and Nurse Practitiner-Led Clinic gverning bdy s mtin indicating their acceptance f a qute. Where ttal facility imprvement cst estimates exceed $10,000, the Nurse Practitiner-Led Clinic NP-led clinic must fllw the requirements as set ut in the Capital Grant and Transitinal Funding A Guide Sheet, and must prvide the ministry with: Cnfirmatin by a qualified prfessinal that all prpsed changes are technically feasible and cmply with applicable cdes, statutes and rdinances A signed letter t the ministry that the cntractr meets the qualifying precnditins as set ut in the Capital Grant and Transitinal Funding A Guide Sheet A preliminary cst estimate that includes a breakdwn f csts fr each element f cnstructin A schedule update that indicates the estimated start and cmpletin dates fr tender f the prject The cmplete bidding/tendering package A detailed analysis f the bids, the recmmended bid, and the ratinale fr endrsing it Cpies f the three lwest bids A signed and cmpleted Final Estimate f Cst (see Appendix H fr sample) and a final cmpletin timeline The Nurse Practitiner-Led Clinic gverning bdy s mtin indicating their acceptance f the bid A signed and cmpleted Final Capital Cst frm (see Appendix I fr sample), upn cmpletin f the facility imprvement, but befre the final payments relating t the facility imprvement have been made A signed and cmpleted Final Submissin f Disbursements (see Appendix J fr sample), after all payments relating t the facility imprvement have been made Prime cnsultant/apprpriate prfessinals t cmplete the Value f the Facility Imprvements template fr facility imprvements that are between $10,000 and $100,000 (see Appendix L fr sample) 22

23 Facility Imprvement Requirements Checklist Phase 2 Requirements An appraisal by a member f the Accredited Appraiser Canadian Institute (AACI) that states the effect f the facility imprvements n the value f the prperty (if applicable, as per the Capital Grant and Transitinal Funding A Guide Sheet), if facility imprvements are ver $100,000 r if deemed necessary Check (/) Cmments 23

24 Appendix D Cmpetitive Bidding Requirements fr Facility Imprvements fr Nurse Practitiner-Led Clinics The purpse f this plicy is t dcument the requirements that the Nurse Practitiner-Led Clinics must adhere t when awarding cntracts in rder t carry ut the apprved facility imprvements. Preliminary Specificatins Prir t assembling a bidding package, the Nurse Practitiner-Led Clinic must prvide the ministry with cmpleted specificatins, wrking drawings and ther dcuments that clearly define the prject scpe f wrk, fr public tendering. Submissin Requirements The design dcumentatin must include the architectural wrking drawings, including the full space requirements, and space apprved by the ministry. Preliminary Cst Estimate The preliminary cst estimate shws a breakdwn f csts fr each phase f cnstructin. Requests fr furniture, equipment, infrmatin technlgy, and telecmmunicatins, shuld be made separately thrugh the Business Plan and Operatinal Plan. Prject Schedule The schedule shuld utline the estimated start and cmpletin date fr each phase f the prject, including tendering f the prject, awarding f the cntract, and cnstructin. Requirements The requirements Nurse Practitiner-Led Clinics must adhere t vary by preliminary cst estimate. Three threshlds have been identified: Tier 1: preliminary cst estimate under $10,000 [requiring qutes] Tier 2: preliminary cst estimate between $10,000 $100,000 [requiring bids] Tier 3: preliminary cst estimate abve $100,000 [requiring bids] Tier 1. Requirements fr facility imprvements with a preliminary cst estimate under $10,000 6 Three cmpetitive qutes are required. The fllwing clause (r a variatin) shuld be included in the request fr qutes frm three general cntractrs/vendrs: "The lwest r any bid will nt necessarily be accepted." The Nurse Practitiner-Led Clinic must prvide the ministry the fllwing infrmatin cncerning the selected cntractr s/vendr s qute: Scpe f wrk (e.g. painting walls, decnstructin, rehabilitatin, plumbing); 6 Please see apprval prcess flwchart in Appendix E fr mre details. 24

25 A detailed breakdwn f cst estimates (e.g. cst f labur, materials); Apprximate start date and cmpletin date; Psitive assessment/review f selected qute by architectural cnsultant/engineer; and Nurse Practitiner-Led Clinic gverning bdy s mtin indicating their acceptance f a qute. The Nurse Practitiner-Led Clinic must keep the three cmpetitive qutes n file and prvide them t the ministry if requested. Tier 2. Requirements fr facility imprvements with a preliminary cst estimate between $10,000 $100,000 7 The Nurse Practitiner-Led Clinics must: Place an ad in the Daily Cmmercial News and the lcal newspaper(s) 8. The advertisement shuld specify, as a minimum: Name f prject; Lcatin f the prject; Name and address f the NP-led clinic; Lcatin where bid dcuments can be picked up and submitted; Cntact persn; Date and time f tender clsing; and The fllwing clause (r a variatin) shuld be included in the advertisement: "The lwest r any bid will nt necessarily be accepted." OR Receive at least three (3) qualified cmpetitive bids 9 frm general cntractrs/vendrs. If they fail t prvide three bids, a ratinale must be prvided, and they can seek prequalificatin f cntractrs as specified in this appendix. General cntractrs/vendrs must, at a minimum 10 : Be bndable r supply a letter f credit in the amunt f the bid; Supply references; Supply a credit check; and Supply prf f cnstructin insurance, if applicable. 7 Please see apprval prcess flwchart in Appendix F fr mre details. 8 There is n need t reference the nearest lcal daily newspaper if there are n daily newspapers in the Nurse Practitiner- Led Clinic s lcatin. 9 The Nurse Practitiner-Led Clinic is strngly encuraged t seek help f a prime cnsultant (typically an architect) wh has experience in dealing with bids, planning and the develpment /tendering prcess (fr prjects that exceed $50,000, a prime cnsultant is mandatry). Where necessary, the prime cnsultant shuld prvide the Nurse Practitiner-Led Clinic with the apprpriate apprvals (e.g. zning, fire marshal, building permits, and bnds). 10 This list is nt exhaustive. The ministry reserves the right t request additinal infrmatin and dcumentatin. 25

26 Nurse Practitiner-Led Clinics must als state in a signed letter t the ministry that the general cntractr/vendr meets the abve precnditins. The prpnent is required t submit t the ministry the fllwing: Prime cnsultant's detailed analysis f the bids and recmmended bid; Cpies f the three lwest bids; Signed and cmpleted Final Estimate f Cst (Appendix H); Nurse Practitiner-Led Clinic gverning bdy s mtin indicating their acceptance f the prime cnsultant's recmmendatins; and Prime cnsultant s reprt that prvides an analysis f the impact f the facility imprvement n the value f the leased prperty (see the sectin entitled Appraisal ). Tier 3. Requirements fr facility imprvements with a preliminary cst estimate ver $100, A full public tendering prcess must be fllwed. Public tendering is the prcess f btaining cmpetitive bids frm prspective general cntractr/vendr t carry ut the wrk identified in the specificatins, which may include the architectural wrking drawings. The ministry s plicies and guidelines fr tendering are based n a stipulated price cntract as per the Canadian Cnstructin Dcuments Cmmittee (CCDC) 2 standard frms and dcuments. The CCDC 2 standard frms are recmmended fr each aspect f the tendering prcess, and are available at The tender package must include the tender frm and instructins t the bidders. They shuld reflect the ministry's guidelines n bnds, insurance, permits and the tender acceptance perid, and any specific dcumentatin relating t staging, decanting and the nging peratin and maintenance f the Nurse Practitiner-Led Clinic during the cnstructin prcess. The tender dcuments are prepared by the prime cnsultant wh is respnsible fr the prcess f calling tenders. Tender calls must be dne by public advertisement, t prvide fr pen cmpetitive bidding. Cnsideratin shuld be given t the use f the Ontari Bid Depsitry n prjects where the estimated cnstructin cst is mre than $2 millin. Standard Rules and Prcedures are available frm lcal bid depsitries. Infrmatin t Bidders The bid dcuments shuld prvide bidders with all the available infrmatin abut the prject. This will minimize questins during the tendering prcess and disputes after the cntract has been awarded. In accrdance with the requirements f the CCDC 2, the Instructins t Bidders shuld include: General Infrmatin Nurse Practitiner-Led Clinic's legal name and address (r name f spnsring legal entity); and 11 Please see apprval prcess flwchart in Appendix G fr mre details. 26

27 Prime cnsultant's name, address and telephne number. Prject Infrmatin Lcatin where the wrk is t be carried ut; Instructins n pricing, e.g. unit price, itemized, alternative and separate prices; and Instructins fr prpsing substitutins r alternatives, s that bidders d nt inadvertently mdify r limit their bids. Bid infrmatin Availability f bid dcuments t general cntractrs and sub-cntractrs; Clear instructins abut the methd, frm and cmpleteness f the bid; Required bid, perfrmance and payment securities; Infrmatin and regulatins fr bid depsitries (if used); Time and place fr receiving bids; Required number f cpies f the bid (usually ne cpy is sufficient); Details f signing, sealing and witnessing; Methd f identifying the envelpe cntaining the bid; Instructins fr amending a bid befre the bid clsing time; Acceptance perid fr bids (such as 30, 45, 60 r 90 days); The fllwing paragraph (r a variatin theref) shuld be included in the Infrmatin t Bidders: "The right t reject any r all tenders in whle r in part r t accept the tender r parts theref judged mst satisfactry is expressly reserved by the Bard f the (insert legal name) Nurse Practitiner-Led Clinic withut liability n the parts f the Bard r the prime cnsultant. The lwest tender will nt necessarily be accepted." Bnds The fllwing bnds are used in a cnstructin prject: Bid Bnd The purpse f the bid bnd is t guarantee the gd faith f the bidder t the Nurse Practitiner-Led Clinic. If the bidder's tender is accepted, the bidder is bligated t enter int a frmal cntract with the Nurse Practitiner-Led Clinic within the time specified and t prvide bnds r ther specified security t secure the perfrmance f the cntract. 27

28 Perfrmance Bnd A perfrmance bnd prvides indemnity t the Nurse Practitiner-Led Clinic up t the amunt f the bnd in case the general cntractr defaults. A perfrmance bnd is nt intended t cver payment f labur and materials claims. Labur and Materials Bnd A labur and materials bnd guarantees that all claimants will be paid fr the labur and material furnished t the general cntractr fr use n the prject, in the event f a default by the selected cntractr. All facility imprvement prjects shuld be cvered by perfrmance bnds and labur and material bnds t at least 50% f the cnstructin cst f the prject. On sme prjects, the ministry may require perfrmance and labur and materials bnds f up t 100%. The general cntractr must prvide the bnds utlined in the tender package. Fr additinal infrmatin n bnds and insurance, refer t Canadian Cnstructin Dcument Cmmittee guidelines. Cnstructin Insurance Large facilities shuld satisfy themselves that existing insurance plicies include cnstructin insurance up t a specified amunt. The Nurse Practitiner-Led Clinic may want t include cnstructin insurance in the bid frm as a separate price and cmpare the cst f purchasing additinal cnstructin insurance directly. If the cst is lwer than the bid cst, the Nurse Practitiner- Led Clinic can c-insure with the cntractr at the lwer cst. Purchasing additinal insurance in n way remves the cntractr s risk and liability, but identifying the Nurse Practitiner-Led Clinic as c-insured n the plicy adds extra prtectin. Public Pre-qualificatin f Bidders An pen tender call with cmpetitive bidding presumes that the finished prduct will be cmparable regardless f which bidder is chsen. Bidders shuld have previus related experience in cnstructin n similar health care facilities and a prven recrd f effective time and cst cntrl. The Nurse Practitiner-Led Clinic shuld allw nly thse cntractrs t bid wh can demnstrate the required experience and financial stability fr the type and size f the prject. If a prject is sufficiently large and/r cmplex r if market cnditins indicate that pre-qualificatin wuld be wise, the Nurse Practitiner-Led Clinic may publicly pre-qualify bidders. The public prequalificatin prcess must cmply with the ministry's plicies fr public tendering and cmpetitive bidding. Public pre-qualificatin allws all ptential bidders t indicate their interest in a prject while enabling the prime cnsultant t develp an apprpriate final bidding list. Only thse cntractrs whse qualificatins are acceptable wuld be permitted t submit bids when tenders are called. The ministry recmmends the use f CCDC 2 (Canadian Standard Frm f Cntractr s Qualificatin Statement) as a minimum requirement f facilities wh are pre-qualifying bidders. T analyze the prequalificatin applicatins, the Nurse Practitiner-Led Clinic must establish an evaluatin cmmittee with the prime cnsultant. This cmmittee develps the evaluatin criteria used t determine the eligibility f prspective bidders. The cmmittee must recrd their analysis and decisins in case there 28

29 are appeals r inquiries. The cmmittee shuld generally chse a minimum f six eligible bidders t ensure fair cmpetitive pricing. The fllwing guidelines will assist in the public pre-qualificatin f bidders: Place advertisements in the daily lcal newspapers and in the Daily Cmmercial News at least three days; Send cpies f these ads t yur Nurse Practitiner-Led Clinic ministry cntact; Have the evaluatin cmmittee review the applicatins fr pre-qualificatin and recrd their analysis and decisins; Chse at least three eligible bidders; Send the names f the qualified general cntractrs/vendrs t yur Nurse Practitiner-Led Clinic ministry cntact; and Encurage all qualified prspective bidders t bid n the prject when tenders are called. Separate, Cntractr's Alternative r Unit Prices On cmplex prjects, it may be in the best interest f the Nurse Practitiner-Led Clinic t request either separate cntractr's alternative, r unit prices n the tender frm. Separate Prices If the Nurse Practitiner-Led Clinic r the ministry is cncerned that a prject may exceed its cst estimate, the Nurse Practitiner-Led Clinic can ask bidders t give separate prices fr specific items. This allws the Nurse Practitiner-Led Clinic t delete r add items at the stated prices. Separate pricing allws the clinic t substitute r delete materials which may imprve the cst r quality f the prject when awarding a cntract t the successful bidder. Cntractr's Alternative Prices Due t rapid changes in technlgy, the Nurse Practitiner-Led Clinic r its prime cnsultant may nt be aware f new r imprved prducts and/r materials n the market at that time. The Nurse Practitiner-Led Clinic can ask a cntractr r sub-cntractr in the field t recmmend alternative prducts r materials f equal r greater value. Unit Prices Unit prices shuld be used with discretin (e.g. the remval f cntaminated sil). In such cases, the quantity f cntaminated sil t be remved shuld be estimated during the tendering prcess. Any amunt ver this quantity wuld be priced thrugh unit prices (i.e. a set price per tnne fr remval f cntaminated sil). The ministry may cnsider cst sharing f change rders related t these types f prjects n a case-by-case basis. Cash Allwances The ministry may apprve cash allwances fr specific items, such as testing, asbests remval and hardware. Because Nurse Practitiner-Led Clinics will enter int fixed-price cntracts, pen ended cntingency cash allwances and/r cntingency allwances/budgets are nt funded by the ministry. 29

30 The ministry shuld identify and apprve prpsed allwances, while the Nurse Practitiner-Led Clinic must justify all prpsals fr cash allwances t the ministry. The fllwing items may be apprved fr cash allwances: Hardware (e.g. dr fasteners); Inspectin and testing; Mdificatins due t final equipment selectin; Replacement f existing elements site cnditins (cntaminated sil, unmarked buried services etc.); and Signage/way-making (directinal signs). Hardware Due t time cnstraints, the prime cnsultant can recmmend tendering f hardware separately after the cnstructin tender. A cash allwance is then carried in the cnstructin tender. The prime cnsultant shuld draw up a detailed hardware list, cmplete with special requirements, t avid extra csts fr installatin. Inspectin and Testing Inspectin and testing allwances are desirable fr such items as sil, cncrete, building envelpe and waterprfing because it is hard t predict the final cst. The Nurse Practitiner-Led Clinic must have an independent surce verify the amunt fr each item. Fr a building with a cmplicated envelpe, the Nurse Practitiner-Led Clinic may cnsider a therm graphic scan. Mdificatins Due t Final Equipment Selectin This type f cash allwance cvers the cst f changes t building services t accmmdate a justified change in equipment. On a lengthy cnstructin prject, equipment mdels can change r specified mdels may n lnger be available. Replacement f Existing Elements This allwance is nt intended t make up fr a lack f preventative maintenance, but t help the NPled clinic achieve the maximum benefit frm facility imprvement funds. Therefre, the Nurse Practitiner-Led Clinic shuld use their discretin when deciding t replace elements such as plumbing valves r windw seals. This allwance is nt intended t cver whlesale replacement f elements. Site Cnditins This type f allwance is put in place t deal specifically with sub-surface cnditins which cannt be determined prir t excavatin (cntaminated sil, unmarked buried services etc.). Calling Tender Calling tender is the methd used fr securing a general cntractr/vendr fr a prject at a fixed cst by advertising in the pen market. Ministry plicy requires that all prjects be publicly tendered. 30

31 Tenders must be prepared based n stipulated price cntracts (CCDC 2). Tenders fr general cntractrs must include all the wrk required t cmplete the prject including specificatins and wrking drawings, if applicable. Tender calls must be publicly advertised in the Daily Cmmercial News and the daily lcal newspapers. Advertisements shuld run fr at least three days and cpies f the advertisements shuld be frwarded t the Nurse Practitiner-Led Clinic ministry cntact. The requirement f public advertising is reinfrced by the brader public service prcurement agreement. This agreement requires that publicly funded prjects with a value greater than $100,000 be advertised in a natinal publicatin such as the Daily Cmmercial News. The advertisement shuld specify, as a minimum: Name and address f prject; Name and address f the Nurse Practitiner-Led Clinic; Lcatin where tender dcuments can be picked up and bids resubmitted; Cntact persn; and Date and time f clsing. The fllwing clause (r a variatin) shuld be included in the advertisement: "The lwest r any tender will nt necessarily be accepted." The ministry recmmends that the Nurse Practitiner-Led Clinic shuld nt accept bids submitted via fax r telephne. Where pssible, tenders shuld be delivered by hand r registered curier due t the cnfidentiality f the submissin and t avid ptential disputes abut the time and/r difficulties encuntered in making the submissin. Opening Tenders The pening f tenders must cnfrm t the prtcl set ut in CCDC 2 (A Guideline t Calling Bids and Awarding Cntracts). The Nurse Practitiner-Led Clinic shuld ntify its ministry cntact f the date, time and lcatin f the tender pening. If the NP-led clinic crdinatr is nt able t attend, the ministry may appint an independent bserver t represent the ministry at the tender pening. The prime cnsultant must indicate in his/her final reprt that CCDC 2 prcedures were fllwed when the tenders were pened. The pening f tenders must be frmal, crrect and well-dcumented. Tenders must be pened publicly at a predetermined lcatin, such as the Nurse Practitiner-Led Clinic r the prime cnsultant's (architect's r engineer's) ffice. Tenders which have been submitted after the specified clsing time shall be returned unpened t the bidder. The fllwing guidelines shuld be adhered t in the tender pening prcess. The Nurse Practitiner- Led Clinic s prime cnsultant pens the tenders and recrds the fllwing infrmatin in the tenderpening register: Names f tendering authrity representatives in attendance; Official time f clsing receipt f tenders; and 31

32 Names and cmpany affiliatin f all persns in attendance. The same prime cnsultant annunces and recrds the fllwing infrmatin: Name f cntractr; Presence f Cnsent t Surety and Bid Bnd (if required); and Tendered price. Evaluating Tenders Tenders shuld be evaluated in accrdance with CCDC 2 strictly enfrcing the requirements respecting signature, seal, security depsit and bnding. As part f the tender evaluatin prcess, the prime cnsultant must: Analyze all pened tenders fr cmpliance with the specific requirements; and Recmmend the lwest bna fide bid. Rejecting Tenders Generally a tender is rejected if: It is in any way limited by the additin r missin f infrmatin; Requirements fr tender surety are nt satisfied; It is nt signed by an authrized persn r it is nt witnessed r sealed; It is nt submitted n the prescribed bid frm; r Changes have been made t the bid frm. A tender shuld be returned t the cntractr unpened if: It is received after the specified clsing time; r Only ne bid is received. The ministry may request cpies f all bids and related infrmatin fr review. Submissin Requirements The Nurse Practitiner-Led Clinic is required t submit t the ministry the fllwing: Prime cnsultant's detailed analysis f the tenders and recmmendatins; Cpies f the three lwest bids; Signed and cmpleted Final Estimate f Cst (see Appendix H); Nurse Practitiner-Led Clinic bard mtin indicating their acceptance f the prime cnsultant's recmmendatins; and Reprt f the appraiser n the impact f the facility imprvement n the value f the prperty (see the sectin entitled Appraisal ). 32

33 Purchasing: Buy Canadian T supprt dmestic markets and supplier develpment, the gvernment ffers a price preference f up t 10% n the Canadian cntent f supplies, equipment and services in bids and prpsals f $25,000 r mre. The ministry recmmends that every cnsideratin be given t Canadian cntent in the award f tenders. Budget The ministry's share f the prject cst is calculated when the Final Estimate f Cst (see Appendix H) is apprved. It includes: General cntract price; Prvincial and federal taxes; Prime cnsultant's fees and disbursements, including building permits; Prject manager/clerk f the wrks (if applicable); Furnishings and equipment; Other allwable csts (such as cash allwances); and Shareable csts and nn-shareable csts. The abve must als identify the cash available and/r the surce f funds fr the Nurse Practitiner- Led Clinic's share f the prject. (See the sectin Shareable/Nn-shareable Csts fr examples.) General Cntract Price This item shuld indicate the name f the successful bidder and amunt f the tender. GST must be shwn separately. Prvincial and Federal Taxes The shareable cst f a facility imprvement prject includes the relevant federal and prvincial taxes less the tax rebates that the Nurse Practitiner-Led Clinic can claim. Prime Cnsultant's Fees and Disbursements The ministry shares the cst f fees fr cnsultants including the building permit, as determined by ministry plicy. If the prject invlves bth renvatins and new wrk, indicate the percentages fr each categry since the fee structure vary. Prject Manager/Clerk f the Wrks The Nurse Practitiner-Led Clinic shuld identify the csts assciated with a prject manager and/r a clerk f the wrks. Prir ministry apprval is required fr cst-sharing in these psitins. Lse Furnishings and Equipment The ministry shares in the cst f the equipment accrding t the apprved equipment list. Other Allwable Csts The ministry may allw cash allwances fr items such as hardware, inspectin and testing. 33

34 Shareable/Nn-shareable Csts Shareable csts are thse which the ministry will share with the NP-led clinic. These include: New cnstructin r renvatin f existing buildings t be used as a health care facility; Fees paid t the prime cnsultant; Fees fr cnsultants ther than thse paid thrugh the prime cnsultant; Basic equipment and furniture and their installatin; Land surveys and sil tests; Necessity landscaping; Legal fees, building permits; and Unfreseeable change rders 12. The ministry des nt cst-share in the fllwing (nn-sharable): Landlrd administratin fees; Kitchen/dietary cnsultants; Interir design cnsultants; Chapel furnishings; Garden areas fr residents/clients; Exterir furnishings fr residents/clients; Land acquisitin r demlitin f existing buildings; Paving f parking lts; Purchase f replacement equipment; Cntingency budgets; Chapel furnishings in hspitals; Financing charges; Gardens, wrks f art and decratins; Campaign csts fr raising the NP-led clinic s share f the apprved csts; Facilities fr ancillary revenue-prducing peratins; Purchase f equipment which is nt part f the prject; Purchase f replacement equipment in hspitals; and Parking facilities. 12 Must be apprved by the ministry prir t undertaking the wrk. 34

35 Methd f Cnstructin Prject Administratin Nurse Practitiner-Led Clinics are encuraged t seek cnventinal cnstructin prject administratin methds. Cnstructin Management (CM) and its variatins are nt an acceptable prject administratin methd. Cnstructin Management is a cnstructin prject administratin methd where the wner/lessee has ne direct cntract with the cnstructin manager, wh seeks sub-cntractrs t prvide the services required t cmplete the facility imprvement. Awarding Cntracts All tender evaluatins, bids and Final Estimate f Cst (see Appendix H fr sample) budgets are reviewed by the ministry. Upn review, the ministry will send a letter t the prpnent advising them f: Apprved ttal prject cst; Apprved facility imprvement grant; and Apprval t sign a cntract. The Nurse Practitiner-Led Clinic shuld nt sign a cntract befre receiving ministry apprval. The ministry can withdraw its funding cmmitment t the prject if a cntract is awarded befre the Nurse Practitiner-Led Clinic receives apprval. Acceptance f the cntract by the Nurse Practitiner-Led Clinic must be dne in writing as it is an agreement between the Nurse Practitiner-Led Clinic and the selected general cntractr/vendr. A Final Capital Cst frm (see Appendix I fr sample), shuld be submitted upn cmpletin f the facility imprvement, but befre the final payments relating t the facility imprvement have been made. A Final Submissin f Disbursements (see Appendix J fr sample), shuld be submitted after all payments relating t the facility imprvement have been made. The Nurse Practitiner-Led Clinic must ensure that they receive a rent-free perid while the facility imprvement is taking place. The ministry will nt pay fr vacancy lss. Appraisal The Nurse Practitiner-Led Clinic is expected t negtiate a discunt in rent equal t the incremental impact f the ministry s investment n the prperty value. In rder t determine the additinal value f the facility imprvement, an appraisal must be cnducted by: References The prime cnsultant/apprpriate prfessinal fr facility imprvements between $10,000 and $100,000; r An appraiser accredited by the Accredited Appraiser Canadian Institute (AACI) fr facility imprvements that exceed $100,000. Ontari. Ministry f Health and Lng-Term Care. Capital Planning Manual. Trnt, ON: Queen s Printer

36 Appendix E Tier 1 Requirements Prcess Nurse Practitiner-Led Clinic t cmplete wrking drawings LEGEND Nurse Practitiner-led Clinic t select cntractr/vendr frm three submitted qutes Activity Cntractr/vendr t frmulate a cst estimate Decisin Pint Cntractr/vendr t determine a cmpletin date End Pint Nurse Practitiner-Led Clinic t award the cntract after review by cnsulting architect / engineer Submit cpies t the ministry 36

37 Appendix F - Tier 2 Requirements Prcess NP-led Clinic t cmplete wrking drawings Prcure building permit: review drawings fr zning, OBC, and building service cmpliance, and revisins f drawings (if necessary) LEGEND Activity Preparatin f package (bid frms, instructins and draft cntract) Ministry apprval f cnstructin drawings and bid package Decisin Pint Place ad seeking cntractr in DCN and daily newspapers End Pint Receive bids and select successful cntractr Nurse Practitiner-Led Clinic t send a letter t the ministry stating that precnditins have been met Send dcuments t the ministry Award cntract Submit cpies t the ministry 37

38 Appendix G - Tier 3 Requirements Prcess NP-led Clinic t cmplete wrking drawings LEGEND Prcure building permit: review drawings fr zning, OBC and building service cmpliance, and revisins f drawings (if necessary) Activity Preparatin f package (bid frms, instructins and draft cntract) Ministry apprval f cnstructin drawings and tender package Place ad seeking cntractr in DCN and daily newspapers Decisin Pint Prequalificatin f cntractrs (ptinal) NP-led Clinic t issue tender package, and cntractrs t submit cmpleted package End Pint Receive bids and select successful cntractr NP-led Clinic t send a letter t the ministry stating that cntractr precnditins have been met Submit prime cnsultant s reprt t the ministry Award cntract Submit cpies t the ministry 38

39 Appendix H Sample Final Estimate f Cst Ministry f Health and Lng-Term Care Final Estimate f Cst (FEC) Facility name Descriptin f prject Tender expiry date Est'd n. f mnths f cnstructin Cnstructin mix % new City/Twn/Twnship % renvatin Ministry prject n. Cntributin A Apprved Cst Amunt Ministry use B C General cntract price (attach list) (breakdwn f actual cst e.g. HVAC System, painting) 1 Other cntracts (attach list) 2 Subttal - Base cst f cntracts 3 $0 Add GST 4 $0 Less GST rebate 5 Subttal A - Grss cst f cntracts 6 $0 Add Cst f: Prime cnsultant's fee 7 Disbursements 8 Other cnsultant's fees (attach list) 9 Lse furnishings & equipment (attach list) 10 Minr equipment allwance (attach list) 11 Other allwable csts (attach list) 12 Subttal (Line 7 t Line 12) 13 $0 Subtract cst f: Other nn-shareable Csts 14 Subttal B (Line 13 minus Line 14) 15 $0 Base f cntributin (Subttal A+B: Line 6+15) 16 $0 Add cst which d nt qualify fr cntributin (see Guide t Transitinal Funding) Other csts (attach list) 17 Cntingency, change rders, etc. (attach list) 18 Subttal C - Nn-shareable cst (Line 17 t Line 18) 19 $0 Final estimate f ttal cst (A+B+C: Line ) 20 $0 Ministry's share f cst 21 D Facility's share f cst (Line 20 minus Line 21) 22 $0 E Funds available t facility fr this prject Cash Cntributin 23 Bnds and securities 24 Other surce (specify) 25 Ttal funds available (Line 23 t Line 25) 26 $0 Deficit r surplus n facility's share (state hw deficit will be financed) 27 The gverning bdy/bard f directrs f the facility hereby accept full respnsibility fr prviding funds t meet their share f the cst, as indicated in Sectin D - Facility's share f cst, and any ther unapprved csts. Signature - Lead/Chair f the Bard/Owner Print Name Ministry apprval Date (dd/mm/yyyy) Date (dd/mm/yyyy) 39

40 Appendix I Sample Final Capital Cst Ministry f Health and Lng-Term Care Facility name Descriptin f prject City/Twn/Twnship Ministry prject n. Final Capital Cst (FCC) Tender expiry date Est'd n. f mnths f cnstructin Cnstructin mix % new % renvatin Cntributin A Apprved Cst Amunt Ministry use General cntract price (attach list) (breakdwn f actual cst e.g. HVAC System, painting) 1 Other cntracts (attach list) 2 Subttal - Base cst f cntracts 3 $0 Add GST 4 $0 Less GST rebate 5 Subttal A - Grss cst f cntracts 6 $0 B Add Cst f: Prime cnsultant's fee 7 Disbursements 8 Other cnsultant's fees (attach list) 9 Lse furnishings & equipment (attach list) 10 Minr equipment allwance (attach list) 11 Other allwable csts (attach list) 12 Subttal (Line 7 t Line 12) 13 $0 Subtract cst f: Other nn-shareable Csts 14 Subttal B (Line 13 minus Line 14) 15 $0 Base f cntributin (Subttal A+B: Line 6+15) 16 $0 C Add cst which d nt qualify fr cntributin (see Guide t Transitinal Funding) Other csts (attach list) 17 Cntingency, change rders, etc. (attach list) 18 Subttal C - Nn-shareable cst (Line 17 t Line 18) 19 $0 Final estimate f ttal cst (A+B+C: Line ) 20 $0 Ministry's share f cst 21 D Facility's share f cst (Line 20 minus Line 21) 22 $0 E Funds available t facility fr this prject Cash Cntributin 23 Bnds and securities 24 Other surce (specify) 25 Ttal funds available (Line 23 t Line 25) 26 $0 Deficit r surplus n facility's share (state hw deficit will be financed) 27 The bard f directrs f the facility hereby accept full respnsibility fr prviding funds t meet their share f the cst, as indicated in Sectin D - Facility's share f cst, and any ther unapprved csts. Signature - Lead/Chair f the Bard/Owner Print Name Ministry apprval Date (dd/mm/yyyy) Date (dd/mm/yyyy) 40

41 Appendix J Sample Final Statement f Disbursements Ministry f Health and Lng-Term Care Final Statement f Disbursements (FSD) Facility name City/Twn/Twnship Prject name Percentage cmplete Date NP-Led Clinic Prject Cmplete and submit annually by March 31st fr each majr prject t Capital & Technical Services, and as sn as pssible after cmpletin f the prject, t initiate final settlement. Cnstructin Cst A Amunt General cntract price (attach list) (breakdwn f actual cst e.g. HVAC System, painting) 1 Other cntracts (attach list) 2 Subttal - Base cst f cntracts (Line 1+2) 3 $0 Add GST 4 $0 Less GST rebate 5 Subttal A - Grss cst f cntracts (Line 3+4-5) 6 $0 B Add Cst f: Prime cnsultant's fee 7 Disbursements 8 Other cnsultant's fees (attach list) 9 Lse furnishings & equipment (excl. replacement equip.) 10 Minr equipment allwance (attach list) 11 Other allwable csts (attach list) 12 Subttal (Line 7 t Line 12) 13 $0 Subtract cst f: Other nn-shareable csts 14 Subttal B (Line 13 minus Line 14) 15 $0 Subttal A+B (Line 6+15) 16 $0 C Add cst which d nt qualify fr cntributin (see Guide t Transitinal Funding) Other csts (attach list) 17 Cntingency, change rders, etc. (attach list) 18 Subttal C - Nn-shareable cst (Line 17 t Line 18) 19 $0 Ttal cst (Subttal A+B+C) (Line ) 20 $0 D Surce f Funds MOH received 21 Ministry use MOH cntributin receivable 22 Other 23 Interest earned n MOH advance funds 24 Facility's wn resurces 25 Ttal surce f funds (Line 21 t Line 25) 26 $0 Signature - Lead/Chair f the Bard/Owner Print name Date (dd/mm/yyyy) Auditr's Reprt: T the Bard f Directrs/Lead/Gverning Bdy This financial infrmatin is the respnsibility f the facility's management; ur respnsibility is t express an pinin n the financial infrmatin based n ur audit. We cnducted the audit in accrdance with generally accepted auditing standards, which require that we plan and perfrm an audit t btain reasnable assurance whether the financial infrmatin is free f material misstatements. An audit includes examining, n a test basis, evidence supprting the amunts and disclsures stated. It als includes assessing the accunting principles used and significant estimates made by management, as well as evaluating the verall presentatin f the financial infrmatin. We have audited the Statement f Disbursement and Surce f Funds fr this prject, fr the perid specified belw. In ur pinin, this statement presents fairly, in all material respects, the funds received and disbursed, in accrdance with generally accepted accunting principles. NP-led Clinic Prject n. Audit perid cvered t: Chartered Accuntants Date (dd/mm/yyyy) 41

42 Appendix K Sample f Lease Infrmatin Schedule Ministry f Health and Lng-Term Care Ministère de la Santé et des Sins de lngue durée SCHEDULE 'XX' This frm shuld be cmpleted by the Nurse Practitiner-Led Clinic Nurse Practitiner-Led Clinic Name: Leased Prperty Address: (If there are multiple prperties, please cmplete a frm fr each lcatin) Street Name and Number: City/Twn: Pstal Cde: Square Ftage: ORIGINAL LEASE PERIOD Net Rent Grss Rent (Add rws if necessary fr different rental rates fr different time perid) LEASE OPTIONS (e.g. Renewal, Expansin) Net Rent Grss Rent (Add rws if necessary fr different rental rates fr different time perid) DURATION Start Date Expiry Date DURATION Start Date Expiry Date $ PER SQ FT $ PER SQ FT PLEASE CHECK IF THE FOLLOWING IS INCLUDED IN GROSS RENT: PROPERTY TAXES MAINTENANCE FEES UTILITIES Cmments NA NA NA PROPERTY TAXES MAINTENANCE FEES UTILITIES Cmments NA NA NA CONDITIONAL CLAUSES Ministry specified clause: An appraisal by a member f the Accredited Appraiser Canadian Institute (AACI) that states the effect f the facility imprvements n the value f the prperty is t be cmpleted fr Ministry funded facility imprvements that are ver $100,000 (r as requested by the Ministry). The lease rate may be subjected t renegtatin if the lease prperty value has increased as a result f the facility imprvements. $ AMOUNT FROM TO TBD Ministry AACI appraiser CONDITION Fr ministry funded leasehld imprvements that are ver $100,000. Ministry specified clause: The value f the facility imprvements template is t be cmpleted by a qualified/apprpriate prfessinal wh is invlved in the facility imprvements fr facility imprvements that are between $10,000 and $100,000. The lease rate may be subjected t renegtatin if the lease prperty value has increased as a result f the facility imprvements. TBD N/A N/A Fr ministry funded leasehld imprvements that are between $10,000 and $100,000. Please list belw clauses that may lead t mnetary transfers between the landlrd, the tenant, r any third parties that are stipulated in the lease agreement r sublease agreements. The fllwing clauses are listed as examples. The landlrd may prvide a cash allwance t the tenant fr facility imprvements Tenant must infrm the landlrd based n the specified ntice date regarding exercising the ptin t either renew r terminate the lease upn expiry $20,000 Landlrd Tenant $10,000 Tenant Landlrd The landlrd is respnsible fr all base building repairs, such as electrical, mechanical, asbests remval (anything behind the walls r in the ceiling); the landlrd may want the tenant t d the wrk and the tenant will be reimbursed via a cash allwance based n cst incurred (invices must be prvided t the landlrd in rder fr the tenant t be reimbursed) r the allwance may be applied t the rental fee. Typically, this clause gives the tenant the pprtunity t ntify the landlrd, in writing, their future space requirements. This ntice date is usually 1 t 2 years befre the lease expiry date and the tenant has t infrm the landlrd if they will be renewing r terminating the lease. If the landlrd des nt receive this written ntice by the specified date, that deems the lease will be renewed. If the tenant decides that they want t mve and missed the ntice perid, the tenant is cmmitted t pay the penalty until the lease expires fr the secnd term. (Add rws if necessary ) I certify that the abve listed infrmatin pertaining t the lease agreement and any sub-lease agreements f the abvementined lease prperty is accurate and that the Ministry may at any time request supprting dcuments fr audit purpses. Authrized Signature: Print Name: Date: Tel. Number: Title: 42

43 Appendix L Sample f Value f Facility Imprvements Template Ministry f Health and Lng-Term Care Ministère de la Santé et des Sins de lngue durée Value f the Facility Imprvements Schedule Family NP-Led Health Clinic Team Name Name Address 1: Street/# Address 2: City/Twn This template is t be cmpleted by a qualified prfessinal/expert n the matter f the lease prperty s facility imprvements: 1. Please prvide a brief descriptin f the facility imprvements: 2. Please input the cst f the facility imprvements: $ 3. Please input the ptential increase in the lease prperty's value frm the facility imprvements: $ 4. Please prvide a brief ratinale n the impact f the facility imprvements n the value f the leased prperty. Please submit supprting dcumentatin n hw the qualified prfessinal/ expert valuatin was determined. I slemnly declare that I d nt have a cnflict f interest n the matter f the facility imprvements and that I have an arms length relatinship with the members f the afrementined Family NP-Led Health Clinic Team and the landlrd f the leased prperty. Prfessinal Title: Prepared by: Signature: 43

44 Glssary Awarding Tender Cntract is awarded t the bard/wner f a registered cmpany/crpratin. Award is based n the prime cnsultant s recmmendatins and the apprval f the Ontari Ministry f Health and Lng-Term Care. Bid Depsitry Bid Depsitry is a methd f bid assembly c-rdinated n behalf f cntractrs t cntrl the bidding prcess. Tendering dcuments are held at a designated lcatin fr review by sub-cntractrs wh then submit sealed bids t perfrm wrk n the prject. General cntractrs that are tendering n the prject include the subcntract bid price as part f their ttal bid n a prject. Bnds Bid A Bid Bnd is required frm a general cntractr when respnding t a tender. It prvides insurance cverage against faulty bids r retractin f a bid after tender pening. Bnds Labur and Material A Labur and Material Bnd guarantees that a claim made fr labur and material furnished t a cntractr will be paid if the cntractr defaults. Bnds Perfrmance A Perfrmance Bnd is purchased by the general cntractr t prtect the wner in the event if general cntractr fails t cmplete the specified prject. Call fr Tenders This is a public advertisement t secure general cntractrs/vendrs t bid n a prject. Canadian Cnstructin Dcuments Cmmittee (CCDC) The Canadian Cnstructin Dcuments Cmmittee is a natinal jint cmmittee respnsible fr the develpment, prductin and review f standards, Canadian cnstructin cntracts, frms and guides. Fr mre infrmatin visit the website at Capital Budget Estimate An estimate f the facility imprvement budget develped during the design phase. It includes estimates fr: - Cnstructin csts; - Architectural/engineering fees and disbursements; - Building permits; - Furniture csts; - Equipment csts; and - Facility s cntributin. Cash Allwance An amunt carried within the tender package fr specifically identified purpses (e.g. hardware allwance). Cash Flw Payments made t a facility r Nurse Practitiner-Led Clinic t meet payment bligatins such as cnstructin csts (e.g. cntractr s invices) based n the cntractr s initial estimate r subsequent updated estimate and the prject schedule. 44

45 Change Orders These are changes t the pricing after the cntract has been signed. Change Order (unfreseeable) Change rders are required after the cntract has been signed and unfreseen issues, which may nt be reasnably ascertained prir t start f the prject r cnstructin (i.e. sil cnditins). Cmmn Space Cmmn r shared space such as hallways, waiting rms, receptin areas, wrking areas in hallways, washrms, administrative areas, administrative ffices, meeting rms, shared exam rms, cleaning clsets, cmputer rm(s). Cntingency Allwance An allwance t cver unfreseen changes during the develpment f a prject. An allwance fr such unidentified, nn-specific items is nt part f the shareable csts f a prject. Cntract Dcuments The final specificatins, including wrking drawings and all ther necessary infrmatin needed fr a facility imprvement prject. Cnstructin Management A cnstructin prject methd where the wner/lessee has ne direct cntract with the cnstructin manager, wh seeks sub-cntractrs t prvide the services required t cmplete the facility imprvement. The ministry des nt accept this prcurement methd fr facility imprvement purpses. Nurse Practitiner-Led Clinics undertaking facility imprvements are encuraged t adpt the Prject Management administratin methd (see definitin belw). Csts Nn-Shareable These are csts incurred in a facility imprvement prject but which are nt eligible fr funding by the ministry (i.e. paving f a parking lt, interir designer fees, ancillary revenue prducing items such as gift shp, cffee shp, etc.). Csts Sharable These are prject csts in which the ministry will cnsider cst-sharing. Decanting Mving f prgram services and patients during the cnstructin phase f a facility imprvement prject. Departmental Grss Area (DGA) The sum f the net areas calculated fr each rm in a given department with an allwance added in fr departmental circulatin and interir walls. Facility Imprvement Budget A facility imprvement budget is finalized after the bidding and negtiatin phase. It itemizes all csts related t a facility imprvement prject, including, but nt limited t: - Accepted bid amunt; - Ttal cnstructin cst; - Cnsultant fees and disbursements; - Furniture and equipment; and - Testing, insurance, permits. 45

46 Facility Imprvements These are imprvements t future r present Nurse Practitiner-Led Clinic site. Renvatins are facility imprvements perfrmed t a prperty that is wned by a Nurse Practitiner-Led Clinic member. Leasehld imprvements are facility imprvements perfrmed t a leased prperty. Nurse Practitiner-Led Clinic Cntact The ministry liaisn persn (cntact) assigned t a specific Nurse Practitiner-Led Clinic. Final Estimate f Cst A frm cmpleted by the facility and frwarded t the ministry listing all csts that will be incurred in the facility imprvement prject and indicating the surce(s) f funds fr the facility s share f the prject. General Cntractr The cntractr is cntractually bligated t a prject requestr. The general cntractr is respnsible fr crdinating the wrk at the cnstructin site, including wrk perfrmed by the sub-cntractrs. Grss Flr Area The ttal flr area f a prject, arrived at by summing department grss area (DGA) and adding an allwance fr majr circulatin rutes between departments, exterir walls and all mechanical cmpnents such as duct shafts, elevatrs, fan rms, and ther cmpnents. Net Cnstructin Cst The tendered price excluding PST and GST. This amunt frms the basis fr the calculatin f prfessinal fees. Net Area This is the sum f the pen flr space requirement f a rm/department. Pre-Qualificatin A prcess whereby cntractrs interested in tendering n a prject are invited by public advertisement t submit their qualificatins fr review by the facility s bard/wner and its architect fr pre-screening prir t submissin f tender bids. Price Unit An amunt stated in a cntract as the price per unit f measurement fr materials r services as described in the cntract dcuments. Price Cntractr s Alternative A substitute item r sectin f the wrk. The price is added r deducted frm the base bid price. Price Separate The price fr wrk t be added r deducted frm the base bid price, if selected by the wner. The separate price is nt included in the base price. Prime Cnsultant An architect r engineer retained by the facility t prepare cntract dcuments fr a facility imprvement prject n behalf f the Nurse Practitiner-Led Clinic. 46

47 Prfessinal Fees The fees and disbursements charged by the prime cnsultant and any sub-cnsultant(s) retained by the prime cnsultant r the facility. Prject Management This is a cnstructin prject administratin methd where the wner/lessee has ne direct cntract with a prject manager, r prime cnsultant, wh navigates and prtects the interests f the wner/lessee thrugh the entire tendering, cnstructin and delivery prcess. Specificatins A part f the cntract dcuments cnsisting f written descriptin f a technical nature f materials, equipment, cnstructin systems, standards and wrkmanship. Statement f Disbursements and Surce f Funds Frm A summary f the prject csts and revenues (including interest earned n ministry advanced funds) prepared by the facility and verified by the facility s external auditrs. Tender The prcess f publicly advertising fr bids frm general cntractrs t perfrm specified wrk at a given price based n a cmpleted set f specificatins. Ttal Prject Cst All the varius csts assciated with a facility imprvement prject including csts fr cnstructin, prfessinal fees, furnishings, equipment, permits, etc. Ttal Cnstructin Csts The cst fr the cnstructin phase f a facility imprvement prject; that is mre accurately determined when the tender bids are received including PST and GST. Transitinal Funding Transitinal funding prvides supprt t Nurse Practitiner-Led Clinic applicants t recgnize the additinal ne-time csts (equipment, furnishings, facility renvatins and related csts) incurred t establish and implement a Nurse Practitiner-Led Clinic. Transitinal funding is supplemental t cntributins frm cmmunity and prvider partners, and is intended t supplement nt replace existing funding surces. Wrking Drawings Drawings intended fr use by a cntractr, sub-cntractr r fabricatin, which frms part f the cntract dcument fr a facility imprvement prject. Wrking drawings cntain the necessary infrmatin t cnstruct r renvate a building. Publicatin # May 2010 Queen s Printer fr Ontari 47