Schedule A RFP Data Sheet

Schedule A to the Request for Proposals - Equipment and Supplies Template Final Version April, 2011 Schedule A RFP Data Sheet

Schedule A to the Request for Proposals Equipment and Supplies Template Final Version April, 2011 Page 1 of 9 RFP DATA SHEET SCHEDULE A TO THE RFP RFP Section 1.1(1) Name of CCAC Name of CCAC: [Insert name of CCAC.] RFP Section 1.1(1) Type of Equipment and Supplies Type of Equipment and Supplies: [Insert type of Equipment and Supplies, as applicable, i.e. Medical Supplies and/or Equipment and Equipment-Related Supplies and/or Infusion Equipment and Infusion Supplies.] RFP Section 1.1(6) Maximum Number of Respondents A maximum of Respondents will be selected as Successful Respondents. [Insert ONE NUMBER ONLY.] [If streaming, you may need to specify a maximum for each stream.] [For example:] Proposal Streams Maximum Number of Successful Respondents Proposal Stream #1 - [Name] A maximum of Respondents will be selected as Successful Respondent Proposal Stream #2 - [Name] A maximum of Respondents will be selected as Successful Respondent RFP Section 1.2 Fairness Representative Name of Fairness Representative and Description of Fairness Representative s Role in this RFP Process: [Insert name of Fairness Representative and a brief description of the Fairness Representative s role in the RFP Process Insert Not Applicable if no Fairness Representative has been retained for this RFP Process.]

Schedule A to the Request for Proposals Equipment and Supplies Template Final Version April, 2011 Page 2 of 9 RFP Section 2.1(2) Applicable Services Schedule and Performance Standards Schedule The following Services Schedules and related Performance Standards Schedules apply to this RFP and the Draft Agreements: [List Services Schedule or Schedules that are applicable. List using exact names of the Services Schedules.] [List Performance Standards Schedule or Schedules that are applicable.] RFP Section 2.1(3) Background Information Document and Data Room Background Information Document/Data Room: [Insert statements as to (i) whether a CCAC Background Information Document is available and how a Respondent can get a copy and (ii) whether there will be a data room.]

Schedule A to the Request for Proposals Equipment and Supplies Template Final Version April, 2011 Page 3 of 9 RFP Section 3.1 Timetable Timetable: (a) Issuance of RFP Documents [Date] (b) Respondents Meeting [Date] [2:00:00 p.m. local time] (c) Background Information Document available [Date] to Respondents [Insert Not Applicable under date if no Background Information Document is being prepared.] (d) Deadline for Respondents to Submit [Date] Questions [2:00:00 p.m. local time] [This date must be after the Respondent s Meeting.] (e) Issue Response to Questions Document [Date] [This date must be at least 2 weeks before the Submission Deadline.] (f) Last day for issuance of Addenda [Date] (Except Addenda related to Timetable changes) [This date must be at least 2 weeks before the Submission Deadline.] (g) Deadline for Submission of Proposals [Date] (Submission Deadline) [2:00:00 p.m. local time] According to the clock at the CCAC reception desk (h) Site Visit Week(s) [Date] (i) Approximate date of identification of Successful Respondents [Date] (j) Approximate date of finalization of Agreement [Date] [Note to CCACs: When completing deadlines, CCACs must follow the Ministry s Policy deadlines, if any, for CCACs.]

Schedule A to the Request for Proposals Equipment and Supplies Template Final Version April, 2011 Page 4 of 9 RFP Section 3.2(1) RFP Coordinator and RFP Coordinator s Designate The coordinates of the RFP Coordinator are: [Name] [Address] [Telephone] [Fax] [E-mail] [Insert: The RFP Coordinator s designate is and add the same information as per the RFP Coordinator, if a designate is going to be named. Otherwise, state, There is no RFP Coordinator designate.] RFP Section 3.2(2)(a) E-mail Address for Submission of Respondents Requests for Clarification [Insert RFP Coordinator s e-mail address or other e-mail address as appropriate for receipt of Respondent s questions.] RFP Section 3.2(3) Response to Questions Document [Insert distribution method that will be used to circulate the Response to Questions Document.] RFP Section 3.3(1) Respondents Meeting The location of the Respondents Meeting is: [Insert Address ONLY.]

Schedule A to the Request for Proposals Equipment and Supplies Template Final Version April, 2011 Page 5 of 9 RFP Section 3.11(1) Prequalification Requirements To be eligible to submit a Proposal in this RFP Process, as of the RFP Submission Deadline, a Respondent must be Prequalified to provide each category of service set out the chart immediately below and must meet the minimum Prequalification Level, as such Prequalification Level was provided to the Respondent by the OACCAC in accordance with the Provincial Prequalification Process, set out in the chart immediately below for each category of service. For clarity, Prequalified Respondents with a Prequalification Level above the minimum Prequalification Level set out in the chart immediately below are also permitted to submit a Proposal in this RFP Process. For example, if the minimum Prequalification Level is Level 3, a Prequalified Respondent with a Prequalification Level of 4 could also submit a Proposal. Category of Service Minimum Prequalification Level Medical Supplies [Insert minimum Prequalification Level or delete row if not applicable to this RFP] Equipment and Equipment Related Supplies [Insert minimum Prequalification Level or delete row if not applicable to this RFP]] Infusion Equipment and Infusion Supplies [Insert minimum Prequalification Level or delete row if not applicable to this RFP]] [Note to CCACs: The decision about which Prequalification Levels will be required in order to participate in a RFP Process are made during a CCAC s RFP planning process. Please see the workbook for further direction.] RFP Section 3.16(2) Proposal Streaming Proposal Streaming [is/is not] applicable to this RFP Process.

Schedule A to the Request for Proposals Equipment and Supplies Template Final Version April, 2011 Page 6 of 9 RFP Section 6.1(3) Price Submission Section Quantity Scenarios [Insert ONE of the following statements: The Respondent is required to submit one set of Price Forms (for ONE Quantity Scenario) The Respondent is required to submit two sets of Price Forms (for TWO Quantity Scenarios. ) The Respondent is required to submit three sets of Price Forms (for THREE Quantity Scenarios) [Note to CCACs: RFP Processes with Proposal Streaming may have Quantity Scenarios for each Proposal Stream. If so, more than three sets of Price Forms may be required. The CCAC should consult the workbook before completing this Section.] RFP Section 7.1(2) Address for Submission Respondents shall submit their Proposals to the following address: [Insert Name.] [Insert Address.] RFP Section 7.5(2) One Proposal per Person or Entity [INSERT EITHER An exception to RFP Section 7.5(2) None.] [Note to CCACs: The CCAC should review the limitations on the permissible exceptions set out in RFP Section 7.5(3) before inserting an exception.]

Schedule A to the Request for Proposals Equipment and Supplies Template Final Version April, 2011 Page 7 of 9 RFP Section 10.3(1) Geographic Designations [INSERT EITHER, The CCAC does not currently intend to apply geographic designations for this RFP Geographic division of the Service Area is dealt with through Proposal Streaming in this RFP The CCAC intends to designate the following geographic areas in the Service Area in accordance with GC Section 3.1.3(2) of the Draft Agreement: Approximate Description of Geographic Area (part of Service Area) Number of Service Providers Expected in Geographic Area RFP Section 13.2 Definitions (LHIN) [Insert name of applicable LHIN]

Schedule A to the Request for Proposals Equipment and Supplies Template Final Version April, 2011 Page 8 of 9 RFP Schedule C - Section 2 [If this RFP is for Medical Supplies only, delete B-7 and B-8.] [If this RFP includes Equipment and Equipment-Related Supplies, delete B-8.] [If this RFP includes Infusion Equipment and Infusion Supplies, all Schedule C Issues apply.] Sub-part and Title Issue B-1 Service Request Service Request Issue: B-2 Delivery and Related Services Delivery and Related Services Issue: B-3 Communication Communication Issue: B-5 Quality Management and Performance Monitoring B-6 Recalls and Defective Products B-7 Risk Management Program and Infection Control B-8 Infusion Equipment and Infusion Supplies Quality Management Issue: Product Quality Issue: Risk Management and Infection Control Issue: Infusion Issue: RFP Schedule E Proposal Streaming Section 1.1(1) [Insert description of proposal streams. Descriptions should be short but specific] Proposal Stream Description Proposal Stream 1 Proposal Stream 2 Proposal Stream 3

Schedule A to the Request for Proposals Equipment and Supplies Template Final Version April, 2011 Page 9 of 9 RFP Schedule E Section 1.2(2) [Insert one of the following statements: The Respondent may submit a Proposal in respect of any Proposal Stream for which it has prequalified. The Respondent may submit a Proposal in respect of any Proposal Stream for which it has prequalified except in the following cases: 1. [For example, the Respondent shall not submit a Proposal in Proposal Stream #1 and #3.] 2. 3. These rules should be discussed with counsel.] RFP Schedule E Section 1.4(2) The Respondent may be awarded any combination of Proposal Streams for which it has been identified as a Successful Respondent except the following: [Insert the combinations of Proposal Streams that are NOT permitted. 11974899.12