REQUEST FOR QUOTATION



Similar documents
REQUEST FOR QUOTATION

How To Quote For The Halifax Regional Municipality

TENDER FOR ROOF REPAIR FOR THE NSLC S METEGHAN RETAIL STORE NOVA SCOTIA LIQUOR CORPORATION 93 CHAIN LAKE DRIVE HALIFAX, NOVA SCOTIA B3S 1A3

Attachment A: Terms and Conditions RFx Bid Opening: 07/06/2016

Village of Nakusp RFQ Source Protection Plan

Sealed bids will be received by the City of Dearborn, at the Office of the Purchasing

Workers' Compensation Board of NS Daily Local Courier Services Request For Quotation

TABLE OF CONTENTS. Prefacej... 1

Attachment A Master Terms and Conditions Page 1 of 5 RFX No TITLE: 3M Petrifilm Products DHH-Office of Public Health

MUNICIPALITY OF CENTRE HASTINGS REQUEST FOR QUOTE

REQUEST FOR QUOTATION (RFQ# INN-ICT-002) New Firewall for Innovacorp Nova Scotia Innovation Corporation (Innovacorp)

REQUEST FOR PROPOSAL

CITY OF CHARLOTTETOWN. REQUEST FOR QUOTATIONS SUPPLY AND INSTALL LIGHTING Municipal Parking Garages

Attachment A Terms and Conditions RFX No TITLE: Quality Control Standards DHH Office of Public Health

REQUEST FOR PROPOSAL: PRT LIVE STREAMING WEBCAMS

QUOTE FOR THE SUPPLY AND INSTALLATION OF METAL GATES AT TRIQ IL-KUCCARD, HAL SAFI

REQUEST FOR QUOTES (RFQ)

Request for Quote Number: PRC Baseball Diamond Backstop Re-Fence

How To Build A Data Backup System In Town Of Trumbull

Kennebecasis Valley Fire Department Inc.

Attachment A Terms and Conditions

COMPETITIVE TENDER 153/16 FOR PROVISION OF DIGITAL MARKETING SERVICES. Closing Date of Tender: 29 February 2016.

REQUEST FOR PROPOSALS FOR Franchise Fees, Sales and Use Tax Audits

Sample Quotation Invitation Document (for goods)

TOWN OF WINDSOR REQUEST FOR QUOTES. Drying Bed Construction

City of Johannesburg Supply Chain Management Unit

City of Plano Municipal Center 1520 Avenue K # 370 Plano, TX 75074

Atrium Skylight Repair Carleton Lodge

REQUEST FOR PROPOSAL TO PROVIDE CONSTRUCTION MANAGEMENT AND GENERAL CONTRACTOR SERVICES SPRINGVILLE CITY NEW AQUATICS AND ACTIVITIES CENTER

Request For Proposal. Furnish Schneider Business Park Signs Design Build Services. For the Cibolo Economic Development Corporation Cibolo, Texas

(House and Land) Approved by the Nova Scotia Real Estate Commission for use by Industry Members under the Real Estate Trading Act.

Canterbury Park Pool Chamber Replacement

Request for Quote. Inland Lakes School Indian River, Michigan. For. Phone System BID PACKAGE

Lorraine Mapela

City of Dallas Specifications for Sewer Camera Maintenance & Repair Services with Parts BM1308

REQUEST FOR STANDING OFFER LOCAL COURIER SERVICES NSLC HEAD OFFICE FACILITY AS PER SPECIFICATIONS

Transcription services for committee minutes

SOLICITATION QUOTATION BLANKET ORDER

CITY OF SAN JOSE REQUEST FOR.QUALIFICATIONS (RFQ) EVALUATOR (ATTORNEY) AND INVESTIGATOR- SAN JOSE ELECTIONS COMMISSION

REQUEST FOR QUOTATION GOODS AND SERVICES RFQ

REQUEST FOR PROPOSAL P PROFESSIONAL TELEPHONE ANSWERING SERVICES

INVITATION TO BID CITY OF HOPKINSVILLE

Regional Council of Goyder

Request for Qualifications (RFQ) Number PUBLIC WORKS CONTINUING CONSTRUCTION AND ENGINEERING INSPECTION AND PROJECT MANAGEMENT SERVICES

Request for Quotation

TENDER TO SUPPLY SHAREPOINT CONTENT MIGRATION TOOL NOVA SCOTIA LIQUOR CORPORATION 93 CHAIN LAKE DRIVE HALIFAX, NOVA SCOTIA

CSA CONSTRUCTION, INC McAllister Road Houston, Texas SUBCONTRACTOR AGREEMENT

SOFTWARE TECHNOLOGY PARKS OF INDIA

International Peace Support Training Centre Westwood Park P O Box Karen, Kenya

REQUEST FOR QUOTE # 20271

FORM A: BID (See B8) 1. Contract Title BEAUJOLAIS COULEE AND BALDRY CREEK FLOOD RESTORATION WORKS

The Generator Loughborough CIC - First Phase Project Development Manager. Job Application

(On behalf of the homeowners) The YUROK TRIBE REQUEST FOR PROPOSAL (RFP)

Request for Proposal

COUNTY OF TANEY, MISSOURI

The Canadian Psychological Association and The Council of Provincial Associations of Psychologists

PIERCE COUNTY LIBRARY SYSTEM. REQUEST FOR PROPOSAL (RFP) for. Telephone Service (Analog Phone Service)

REQUEST FOR QUOTE NUMBER: 09RD65575YB WILL BE RECEIVED UNTIL 1/21/2009

Procurement Department REQUEST FOR QUOTATIONS. For Blanco Apartments Minor Roof Repairs. For

Provision of Accounts Payable Service

GREENFIELD MIDDLE SCHOOL ROOF PROJECT

PROPOSAL DOCUMENT LEGAL NOTICE - PROPOSALS WANTED GENERAL INFORMATION AND INSTRUCTION (IF YOU CHOOSE NOT TO SUBMIT A PROPOSAL, PLEASE COMPLETE PAGE )

DAKOTA COUNTY TRANSPORTATION DEPARTMENT GUIDE TO BIDDING TRANSPORTATION PROJECTS

Request of training on Operational Risk Management

CITY OF LAREDO PURCHASING DIVISION TERMS AND CONDITIONS OF INVITATIONS FOR BIDS

SEALED BID SOLICITATION QUOTATION

LEGAL NOTICE REQUEST FOR BID SEALED BID For SQL MONITORING SOFTWARE RE-BID. For ST. CHARLES COUNTY GOVERNMENT ST.

Request for Quotation

How to Do Business With Us ST. LOUIS COUNTY GOVERNMENT DIVISION OF PROCUREMENT AND ADMINISTRATIVE SERVICES

SAMPLE VENDOR AGREEMENT VENDOR # Sample Vendor, Vendor Title Sample Vendor Company. Evelyn V. Martinez, Executive Director

REQUEST FOR QUOTE NUMBER: 10RD75957YB WILL BE RECEIVED UNTIL 11/5/2010 at 2:00 p.m.

Project Management Agreement

A Supplier Guide to Providing Services and Commodities to NEW YORK UNIVERSITY F&CM CONTRACT MANAGEMENT

GORDON COUNTY BOARD OF COMMISSIONERS REQUEST FOR QUALIFICATIONS FOR AN ARCHITECT FAMILIAR WITH COMMUNITY DEVELOPMENT BLOCK GRANT APPLICATIONS

TOWN OF GROTON INVITATION TO BID ARCHIVING SYSTEM

STATE BANK OF SPRING HILL INTERNET BANKING AGREEMENT Internet banking is not available to children under 18 years of age.

Yagan Moodley Tel : (011)

Quotations for Small Purchases (QSP) CONDITIONS TO QUOTE

REQUEST FOR QUOTATION

HOW TO DO BUSINESS WITH THE CITY OF WICHITA KANSAS FINANCE DEPARTMENT PURCHASING

INSTRUCTION FOR COMPLETING COMPETITIVE SOLICITATION ACKNOWLEDGEMENT FORMS

REQUEST FOR PROPOSALS

Transcription:

REQUEST FOR QUOTATION RFQ number/date RFQ Collective Number Q14M110 Contact person/telephone Mitchell Crowell/902 490-4207 This number must appear on all invoices lading bills, containers and correspondence. Send queries DIRECT to Purchasing Agent. Please send completed RFQ to: Halifax Regional Municipality Procurement Division Suite 103, 40 Alderney Drive, Dartmouth, NS B2Y 2N5 THIS IS NOT A PURCHASE ORDER Quotation deadline: 2014.08.07 Name of Company Quoting Request for Quotation for Halifax Regional Municipality(HRM) Quotation Q14M110 Supply and Install Door Components-Scotia Bank Centre (formerly Halifax Metro Center) Description of requirement: Listed below Under Scope of Work are the specifications requirements for the door components at Scotia Bank Centre (formerly Halifax Metro Center) entitled HMC Doors-Scope of Work. Submission of Vendors Alternative Door Components for Approval: Halifax Regional Municipality will consider vendors suggested approved alternative for door components items and 3'x 7' steel door and frame etc Item #13A in HRM Quotation Q14M110. ****************************************************************

2 Submissions must be received by HRM Procurement by Monday, July 28/14 4pm Atlantic Standard Time. Submissions for Vendors door components equipment for Approval after 4pm July 28/14 can not be consider for this quotation. Submission of Vendors Alternative Door Components for Approval to be deliver to Halifax Regional Municipality Procurement Office, Suite 103, 40 Alderney Drive, Dartmouth, NS. by Monday, July 28/14 4pm Atlantic Standard Time. **************************************************************** Submission of Vendors Alternative Door Component Equipment for Approval Must provide One(1) Original and One(1) Copy in sealed envelope marked on outside of the envelope Vendors for Alternative Door Component Equipment Approval-HRM Quotation Q14M0110 Scotia Bank Centre(formerly Halifax Metro Centre). No fax or e-mail Submissions are acceptable. Submission for each product must have following information HRM Item# and Item Description located on HRM Scope of Work section or price page for EACH item the vendor is requesting approved alternative product. Vendor to state below HRM Item# and Item Description, vendors alternative product stating the manufacturer, brand name, model and Manufacturer Part# for the item. Bidder to submit with Each Alternative Item, specifications for that product E.G. North Sports Bar - east HRM Item 1B Acceptable Product Sargent 8504 862 32D Narrow Design Rim Device Contractors Suggested Approved Alternative Product E.G. MITCHELL CROWELL 10101010 Narrow Design Rim Device Reference: HRM Trade Center Mitchell Crowell Tel 490 4207 client Judi Rahey, Trade Centre Tel 421 1302 Ext.2716 supply to Trade Centre Must supply literature and specification on contractors alternative products recommending for each item. Bidders shall provide one(1) applicable client contact who the vendor or manufacturer have contracted for each vendor's alternative door component product offered by the contractor. The list should include the following information for each item: 1. Company Name and Address 2. Client's Contracting Officer and Telephone Number (Purchaser) 3. Client's Technical Representative and Telephone Number (where different), and

3 4. A brief, written description of the specific goods provided including the year and contract value. This is what is required for HRM to review if thecontractors product(s) would be acceptable alternative product. HRM and Trade Centre Staff will make its decision base on infomation provided. It is the Bidder's responsible to provide the information required that shows the product would be alternative product re features, quality and warranty etc. HRM decision is final, products not accepted as approved alternative, the bidder will be given the reason(s) why it did not meet spec requirements or what information was not provided as required which make your alternative non complaint etc. HRM Procurement will issue an addendum at least three working days before the closing date stating the approved alternatives for Each Item. If the addendum is issued less than three working days from the closing date,the closing date for the quotation will be extended. Closing Date: Quotation Q14M088 closing Thursday, August 07/14 at 4:00 pm Atlantic Standard Time (AST). Quotations can be delivered to HRM Procurement located at Alderney Gate, 40 Alderney Dr., Suite# 103, Dartmouth NS, or faxed to Mitchell Crowell, HRM Procurement at(902)490-6425. HRM Standard Terms & Conditions: The Terms and Conditions for this solicitation can be located at either the www.halifax.ca website at: http://www.halifax.ca/procurement/terms.html or picked up at the Procurement Office, 40 Alderney Dr., Suite# 103, Dartmouth NS. Submission of a response to this Request for Quotation confirms that your company has viewed and accepts these Terms and Conditions. Supplementary Terms and Conditions: Questions concerning specifications,requirements or application contact Judi Rahey, Trade Cente at 421 1302 ext 2716 Questions concerning the terms and conditions or the procurement process contact Mitchell Crowell at 490 4207 or e-mail crowelm@halifax.ca Requesting changes to the terms and conditions must be requested by e-mail at least three business days before

4 the quotation closes. The subject of the e-mail to state "change request to HRM Quotation Q14M110". Any changes to the spec to be valid HRM Procurement must issue an addendum noting the change and post to Province of Nova Scotia Procurement Website. Workers Compensation, Safety and Insurance requirements same as stated in HRM Standard Terms and Conditions. NOTE******************************************************* Contractors must provide their updated valid letter of Good Standing from Workers Compensation and updated valid letter from endorsed Workers Compensation Board Audit Firm re health and safety management program (must be WCB Safety Certified, or Certificate of Recognition, Audit Pending or In -Process) with HRM Quotation Form Q14M110 by closing date *********************************************************** Bidders shall provide a list of three (3) applicable client contacts who have contracted for services offered by the proponent which is considered identical or similar to the requirements of this Request. The list should include the following information: 1. Company Name and Address 2. Client's Contracting Officer and Telephone Number(Purchaser) 3. Client's Technical Representative and Telephone Number (where different), and 4. A brief, written description of the specific goods or services provided including the year and contract value. Return with HRM Quotation Q14M110 This quotation job will be awarded depending on budget approval and funding for this project less any discount payment terms. Pricing will not be released until funding is in place and this quotation is awarded. Contractors will be given the name of the low price bidder only if requested. This quotation is not a public opening. The Contractor shall properly execute and complete all of the work indicated and called for in the specifications The Contractor shall co ordinate all divisions of the work including the work of all sub contractors and suppliers. Be responsible for scheduling and expediting their work and deliveries, including correction of all defective work. The Contractor shall be responsible for compliance by all persons or parties engaged on the work with all laws, building codes and ordinances insofar as they apply to work carried out under this quotation.

5 The Contractor shall obtain all permits, licenses and certificates,and pay all fees required for the performance of the Work which are in force at the date of quotation submission. Contractor must have adequate equipment and qualified staff to expediently complete the job in an efficient workperson like manner. Service: Equipment must be serviced by a local company or if not HRM/Trade Center will not pay any costs other than on site labour and parts once the warranty period has expired. Health and Safety Act Every contractor shall take every precaution that is reasonable in the circumstances to ensure that every employee, self employed person and employer performing work in respect of the project complies with the latest revision of the Nova Scotia Health & Safety Act and Regulations, HRM Health & Safety Regulations and all other safety measures as required by authorities having jurisdiction. Safety Plan Within five (5) days notification of award the contractor shall provide Judi Rahey, Halifax Metro Centre Project Manager with a safety plan per Judi Rahey e-mail address judi@tclns.com This plan shall include but not be limited to identification of safety hazards anticipated during the project, solutions to those hazards, safety procedures, identification of designated safety officers and provisions for safe access to the site work for HRM staff. Receipt and acceptance of the safety plan shall be mandatory prior to commencement of work. Examination of Site All contractors who may in any way be affected by the existing conditions of the site will be held to have examined the site and familiarized themselves with the character and extent of work necessary to complete the contract according to the specifications. No claims for extra payment will be entertained by reason of difficulties encountered due to conditions of the site which were visible or reasonably inferable from an examination of the site prior to delivery of this quotation. Contact Judi Rahey if you require to view the site at 421 1302 ext 2716. Deduction for Uncorrected Work Trade Centre Project Manager may deem it to be in the best interests of the Trade centre to make an appropriate deduction in the Contractor's payment where work has been damaged and/or does not comply with the Contract. Notice of Completion

6 When work is complete,request in writing that a final inspection be made by Trade Centre Project Manager. Upon the Owners and/or HRM's concurrence that the work is complete, attend the final inspection and participate in the preparation of a deficiency list. Deficiency Corrections Correct all deficient items and advise Trade Centre Project Manager in writing when complete. Scope of Work: HMC Doors - Scope of Work Please note: ** Where applicable, current door models are listed. Trade CENTRE will accept the replacement of the exact model and consider approved alternative model To supply and install the following door components on specified locations of the Scotia Bank Centre(formerly known as Halifax Metro Centre) 1. North Sports Bar - east: A. Replace: Door Handles on three (3) sets of glass/aluminum double doors (6 handles in total) B. Replace: Exit Devices (panic sets with internal locking system - only) on 3 sets of glass/aluminum doors - 6 exit devices in total. Exit Device Manufacturer preference to be: Sargent 8504 862 32D Narrow Design Rim Device. C. Replace: Trim pieces on two (2) aluminum side lites. D. Replace: All Thresholds on three (3) sets of double doors. (Current Door Model: Zimcor) 2. North Sports Bar - west: (closest to west brick wall) A. Replace: Two (2) sets of glass/aluminum double doors c/w new door frames, hardware, door closers, hinges, exit devices (panic sets with internal locking system - only). Exit Device Manufacturer preference to be: Sargent

7 MD 8404 862 32D Narrow Design Rim Device. B. Hinges: To be standard commercial stainless steel ball-bearing with Non-Removable Pin. C. Replace: All Thresholds on these two (2) sets of double doors (Current Door Model: Kawneer) 3. North Promenade: A. Replace: All Thresholds on three (3) sets of double glass/aluminum doors. B. Replace: Trim piece on one (1) side lite. (Current Door Model: Zimcor) 4. North 97 Level: A. Replace: All door sweeps. B. Replace: All thresholds on these 2 sets of double doors. (Current Door Model: Kawneer) 5. Mooseheads Admin Office: A. Replace: One (1) threshold on inside glass/aluminum door. (Current Door Model: Kawneer) 6. Duke & Brunswick Sts. - corner: A. Replace: One (1) Roton hinge on one (1) glass/aluminum door. (Current Door Model: Alumicor) 7. Brunswick St. (1st set): A. Replace: Two (2) corner trim pieces and four (4) thresholds. (Current Door Model: Alumicor) 8. Brunswick St. (2nd set): A. Replace: Two (2) thresholds. (Current Door Model: Alumicor)

8 9. Carmichael/Brunswick (corner) A. Replace: All Thresholds. B. Replace: One (1) corner trim piece on a side lite. (Current Door Model: Alumicor) 10.Carmichael St. Security Entrance: A. Replace: One (1) set of metal double doors c/w new door frames, hardware, door closer, handle, panic set with internal locking system - only. B. Replace: Thresholds. C. Door: To have 1-way Security 'pinhole'. 11.South Promenade: A. Replace: Hinges on three (3) sets of glass/aluminum double doors. B. Replace: All Thresholds. C. Hinges: To be standard commercial stainless steel ball-bearing with Non-Removal Pin (Current Door Model: Zimmcor) 12.South Sports Bar: A. Replace: All exit devices (panic sets with internal locking system - only) on 3 sets of double glass/aluminum doors. Exit Device Manufacturer preference to be: Sargent 8504 862 32D Narrow Design Rim Exit Device. 13.N.S. Power - Entrance to Vault: A. Replace: 3'x 7' steel door and frame complete Pricing Section ITEM#1 North Sports Bar-East

9 1A 1B 1C 1D _ Item#2 North Sports Bar-West(closest to west brick wall) 2A 2B 2C Item#3 North Promenade 3A 3B Item#4 North 97 Level

10 4A 4B Item#5 Mooseheads Admin Office 5A Item#6 Duke & Brunswick STS-Corner 6A Item#7 Brunswick St.(1st set) 7A

11 Item#8 Brunswick St.(2nd set) 8A Item#9 Carmichael/Brunswick (corner) 9A 9B Item#10 Carmichael St. Security Entrance 10A 10B 10C Item#11 South Promenade

12 11A 11B 11C Item#12 South Sports Bar 12A Item#13 N.S.Power-Entrance to Vault 13A Grand Total Lump Sum inclusive Cost(supply,deliver remove,and install door components for the above thirteen(13) items $ plus HST Provide copy of printout or adding machine tape to verify the above grand total inclusive cost.

13 Warranty on above equipment: ITEM# product warranty Warranty on Labour Completion Schedule: After receiving HRM award letter, how many work days for HRM receives contractors insurance with Halifax Regional Municipality added as additional insured for commercial general liability insurnce policy. Number of work days After HRM awards and provides the contractor with HRM Purchase Order, how many work days before this project will be started

14 Number of work days After starting the work, how many work days to complete the work Number of work days Does contractor offer any special payment terms, if yes payment terms are If not, payment terms are NET 30 after Trade Centre Project Manager signs off as work completed. Contractor to state any subcontractors the contractor will be using and what the subcontractor is doing, please list below: Contractors information: Contractor's Safety Officer's Name Tel# cell# Fax# E-mail address Contractor's supervisor on site Name Tel# cell# Fax#

15 E-mail address Contractor's back-up supervisor on site Name Tel# cell# Fax# E-mail address Contractor's person who will oversee this project Name Tel# cell# Fax# E-mail address Contractor Quoting: Name of the Company (Print) Address of the Company Province Postal Code TEL# FAX# CELL# E-MAIL Address HST# OR GST# Name of Company Rep(PRINT) Signature of Company Rep

16 Date QUOTATION Q14M110 Mitchell Crowell, HRM Procurement Officer Tel 490 4207 Fax 490 6425 Service: Equipment must be serviced by a local company or if not HRM will not pay any costs other than on site labour and parts once the warranty period has expired. Health and Safety Act Every contractor shall take every precaution that is reasonable in the circumstances to ensure that every employee, self employed person and employer performing work in respect of the project complies with the latest revision of the Nova Scotia Health & Safety Act and Regulations, HRM Health & Safety Regulations and all other safety measures as required by authorities having jurisdiction. Safety Plan Within three (3) days notification of award the contractor shall provide david carr(email address carrd@halifax.ca ) with a safety plan. This plan shall include but not be limited to identification of safety hazards anticipated during the project, solutions to those hazards, safety procedures, identification of designated safety officers and provisions for safe access to the site work for HRM/Sackville Sports Stadium staff. Receipt and acceptance of the safety plan

17 shall be mandatory prior to commencement of work. Examination of Site All contractors who may in any way be affected by the existing conditions of the site will be held to have examined the site and familiarized themselves with the character and extent of work necessary to complete the contract according to the specifications. No claims for extra payment will be entertained by reason of difficulties encountered due to conditions of the site which were visible or reasonably inferable from an examination of the site prior to delivery of this quotation. Deduction for Uncorrected Work HRM Project Manager may deem it to be in the best interests of the HRM to make an appropriate deduction in the Contractor's payment where work has been damaged and/or does not comply with the Contract. Notice of Completion When work is complete, request in writing that a final inspection be made by HRM Project Manager. Upon the Owners and/or HRM's concurrence that the work is complete, attend the final inspection and participate in the preparation of a deficiency list. Deficiency Corrections Correct all deficient items and advise HRM Project Manager in writing when complete. Contractors information: Contractor's Safety Officer's Name tel# cell# fax# e-mail address Contractor's supervisor on site Name tel# cell#

18 fax# e-mail address Contractor's back-up supervisor on site Name tel# cell# fax# e-mail address Contractor's person who will oversee this project Name tel# cell# fax# e-mail address Contractor Quoting: Name of the Company (Print) Address of the Company Province Postal Code TEL# FAX# CELL# E-MAIL Address HST# OR GST# Name of Company Rep(PRINT) Signature of Company Rep

19 Date QUOTATION Q14M110 Mitchell Crowell, HRM Procurement Officer Tel 490 4207 Fax 490 6425 Item Material Description RFQ quantity Unit Deliv. date. Unit price 00010 S/I Door Components Scotia Bank Centre 1.000 each $ Terms and Conditions The Terms and Conditions for this solicitation can be located at either the www.halifax.ca website at: http://www.halifax.ca/procurement/terms.html or picked up at the Procurement Office, 1st Floor, Suite 103, 40 Alderney Drive, Dartmouth, NS. Submission of a response to this Request for Quotation confirms that your company has viewed and accepts these Terms and Conditions.

YOUR ATTENTION TO THIS REQUIRED IMMEDIATELY ATTENTION CONTROLLER PLEASE FILL OUT AND RETURN ASAP ELECTRONIC PAYMENT REGISTRATION FORM Electronic commerce has changed business practices globally. These changes allow HRM to work more efficiently with vendors on day-to-day business transactions. The Halifax Regional Municipality electronic payment process is fully in place to enroll all vendors doing business with HRM. Payment of invoices electronically will benefit you immediately through: The elimination of your time spent depositing payments Immediate access to your funds on the payment date The elimination of delivery disruptions due to Postal delays or lost mailings The elimination of the threat of fraud, lost or stolen cheques In order to register to receive electronic payments of invoices from Halifax Regional Municipality, please complete this form and attach a voided cheque if applicable. The form must be signed by a designated signing officer of your company. HOLD HARMLESS CLAUSE: The Halifax Regional Municipality and its banker are entitled to rely on the information supplied by you. Payments made to the benefit of the beneficiary vendor to the account identified herein shall satisfy the obligation of the Halifax Regional Municipality to the beneficiary vendor respecting the amount paid. It is the responsibility of the beneficiary vendor to insure that payments are actually received. PAYMENT INFORMATION Vendor Name: HST registration number: (If applicable) The voided cheque or Bank transmittal form supplied by your Financial Institution, will provide us with all the necessary Banking information. *Note Do not send in if you re already enrolled for Electronic Payment with HRM

REMITTANCE INFORMATION Please indicate how you would prefer to receive your payment details. (Please check one) E-mail address:. No remittance advice necessary Contact Name: Title/Position: Phone ( ) Fax: ( ) I/We (the undersigned) hereby authorize Halifax Regional Municipality to make deposits to our account as per the information provided above and deliver remittance as indicated. I/We acknowledge responsibility to ensure the correctness of the information, to confirm receipt of the payment funds, and to immediately advise Halifax Regional Municipality if payment is not received. Signature: Signature : Date: PLEASE RETURN THE COMPLETED FORM BY MAIL, FAX, OR EMAIL TO: Halifax Regional Municipality Attention: Joe Colley Finance Division P.O. Box 1749 Halifax, NS B3J 3A5 Fax #: (902) 490-4175 Telephone#: (902) 490-7357 Email: colleyj@halifax.ca