The Metropolitan St

THE METROPOLITAN ST. LOUIS SEWER DISTRICT 2350 Market Street St. Louis, MO 63103

Attn: Purchasing Department Amanda Cooper (314)768-6329 Or Lisa Treat (314)768-6269

2014-2015 PRE-QUALIFICATION QUESTIONNAIRE

(USED IN PRE-QUALIFYING BIDDERS ON CONSTRUCTION WORK)

______SUBMITTED BY (COMPANY) ______ADDRESS ______CITY, STATE, ZIP CODE ______DATE

______CONTACT NAME (FOR QUESTIONS) - TELEPHONE & FAX

TAX ID NUMBER ______E-MAIL ADDRESS

of 44 rev 2-9-15 PREQUALIFICATION CHECK LIST Below is a checklist of required documentation

 Signed application and boxes checked indicating type of work requested – (Page 9).

 Signed Conflict of Interest Statement (Page 5).  Bonding capacity indicated (Page 10)  Equipment Sheet is complete (Page 26)  Affidavit is complete with Notary Seal (Page 27, 28, or 29), whichever is applicable.  Attach Certificate from the Secretary of State showing company is authorized to transact business in the State of Missouri.  Attach ACCORD Certificate of Insurance with MSD as certificate holder.  Attach drain layers license for City of St. Louis and/or St. Louis County (required for Sewer Construction and Deep Sewer Construction categories)  Demolition work for MSD within the City of St. Louis – attach certification for specific classification. o Class I – no building size restrictions. o Class II Limited to buildings under 3 stories/50 feet high/50,000 square feet area/200,000 cubic feet volume. o Buildings under 1 ½ stories/10,000 cubic feet volume, with no basement, require no demolition license. o St. Louis County does not require license.

of 44 rev 2-9-15 RULES AND REGULATIONS FOR PREQUALIFICATION OF CONTRACTORS ON WORK LET BY CONTRACT WITH THE METROPOLITAN ST. LOUIS SEWER DISTRICT

1. An applicant for pre-qualification must furnish, under oath, detailed information with respect to its equipment, past record, personnel, and experience, together with other information as is called for in this Experience Questionnaire. 2. A contractor must be prequalified prior to the bid being opened. 3. Any combination of qualified or unqualified contractors bidding jointly becomes a new contracting firm and it must be pre-qualified in accordance with these rules. All applications shall be in writing and signed by the principal parties in the joint venture. 4. A Pre-qualification Questionnaire on forms furnished by the Purchasing Manager must be filed BY October 1st of each year in order to renew pre-qualification. This form must be completed in detail. The District may require any additional information deemed necessary for pre-qualification. Companies pre-qualified within 3 months prior to this date will not need to submit a renewal application until October 1 st of the following year.

5. No bidder will be pre-qualified unless its Pre-qualification Questionnaire indicates that it has the experience, organization, and equipment, sufficient in the judgment of the District, that it can satisfactorily execute its contracts and meet its obligations therein incurred. 6. The Financial Statement of the controlling individual or corporate owner of the business shall be submitted; if in the opinion of the District it is required. 7. If any significant change occurs in the information included on the contractors’ pre- qualification form, notice shall be given to the District immediately. 8. All corporations must furnish a certificate from the Secretary of State showing that it is authorized to transact business in the State of Missouri 9. A copy of your firm's Certificate of Insurance meeting the Districts coverages is required. 10.A copy of the applicable drain layers license from the City and/or County of St. Louis is required for Sewer Construction or Deep Sewer Construction. 11. Demolition work for MSD within the City of St. Louis – attach certification for specific classification. o Class I – no building size restrictions. o Class II Limited to buildings under 3 stories/50 feet high/50,000 square feet area/200,000 cubic feet volume. o Buildings under 1 ½ stories/10,000 cubic feet volume, with no basement, require no demolition license. o St. Louis County does not require a license. NOTE: It is important that the "work experience" section be completed and that it contains projects of the type for which pre-qualification is being requested. Pre- qualification will not be granted for types of work that you subcontract to others.

of 44 rev 2-9-15 IMPORTANT INFORMATION FOR PROSPECTIVE BIDDERS

1. CONTRACT DOCUMENTS Contract documents include, but may not be limited to, the advertisement, Instructions to Bidders, Proposal, General Specifications, Detailed Specifications, Agreement, Bond Form, and Plans. The documents are available on and after the day advertisement is published and will be available via MSD’s website at www.stlmsd.com. Look for a link to “ELECTRONIC PLANROOM”. Plans and specifications are also available for viewing or purchase at Cross Rhodes Reprographics located at 1710 Macklind Avenue, St Louis MO 63110.

2. DEPOSIT FOR DOCUMENTS The charge for contract documents is not refundable.

3. PREQUALIFICATION Bidders not already pre-qualified may make application for pre-qualification to the Purchasing Manager, The Metropolitan St. Louis Sewer District, 2350 Market Street, St. Louis, MO 63103. A contractor must be pre-qualified prior to bids being opened.

4. SPECIAL PROVISIONS Any special provisions or requirements concerning the work on any particular contract will be noted in the contract documents or on the Plans.

5. MINIMUM WAGE AND EMPLOYMENT DISCRIMINATION The minimum wage to be paid to all labor will be shown in the contract documents where applicable. Prevailing rates of pay shall be paid to skilled and unskilled labor, and there shall be no discrimination in the selection or employment of labor on account of race, creed, or color.

6. BID DEPOSIT The bid shall be accompanied by a certified check or cashier's check drawn on a bank or trust company located in either St. Louis City or County or by a bid bond issued by a surety company satisfactory to the District and which is authorized to transact business in Missouri.

7. RIGHT TO REJECT The Metropolitan St. Louis Sewer District reserves the right to reject any and all bids and to waive technicalities.

of 44 rev 2-9-15 VENDOR’S CONFLICT OF INTEREST QUESTIONNAIRE

1. Name the individual or company requesting to do business with The Metropolitan St. Louis Sewer District (MSD).

2. In the past two (2) years has the individual or company name in 1. above (or any principal of such company, i.e. partner, officer, director, etc.) contributed cash or gifts in excess of $200.00 in value in the aggregate in any calendar year to any of the individuals or organizations listed on Attachment A hereto?

Yes No If yes, describe in detail (date/amount/description).

1. In the past two (2) years, has the individual or company named in 1. above done business with any person listed in Attachment and/or their respective companies.

Yes No If yes, describe in detail (date/amount/description).

4. The undersigned certifies that the above information is true and correct to the best of his or her knowledge and belief.

Dated this day of ______. 20 _

Printed Name: _____

Title: _____

Company Name: _____

Signature: _____

of 44 rev 2-9-15 MSD BOARD OF TRUSTEES Trustee/Director Name of Firm, Organization or Company Affiliation Brian Hoelscher American Public Works Association Member American Society of Civil Engineers Member Engineers Club of St. Louis Member Labor and Employment Relation s Association; Member Gateway Chapte Misrsouri Water Environment Association Member Water Environment Federation Member

Annette K. Mandel Central West End Planning & Development Committee Member Missouri Bar Association Member USO MissouriVolunteer West Point Parents Club Member

Barbara Mohn Water Wastewater CIO Forum Member

Susan M. Myers Association of Corporate Counsel Member Bar Association of Metropolitan St. Louis Member Missouri Bar Association Member

Valerie Patton Delta Sigma Theta Sorority, Inc. Member Howard University Alumni Club of St. Louis Member National Association of Social Workers Member St. Louis Gateway Classic Sports Foundation Board Member The Links Incorporated Member, Treasurer United Way of Greater St. Louis Board Member, Member, Audit Committee, Member, Organizational Development Committee, Member, CEO Search Committee University of Missouri-St. Louis - College of Board Member Business Administrati Board Member on Washington University in St. Louis - Alumni Board of Governor s Betsy Schubert Institute for Supply Management Member

of 44 rev 2-9-15 Timothy R. Snoke Institute of Management Accountants Member St. John's Lutheran Church Member St. John's Lutheran School Board of Education Chair St. Louis Treasury Management Association Member

Jonathon Sprague American Public Works Association (APWA) Member American Water Works Association (AWWA) Member Engineers Club of St. Louis Member Missouri Water Environment Member National Association of Clean Water Agencies (NACWA) Member Water Environment Federation Member

of 44 rev 2-9-15 Vicki Taylor- AAIM Management Association Member Certified Employee Benefits Association Member Compensation Benefits Network Member Human Resources Management Association Member International Public Management Association Member

Rich L. Unverferth American Society of Civil Engineers Member Engineers Club of St. Louis Member Knights of Columbus - Council 2119 Webster Member NatiGrovoesnal Association of Clean Water Agencies Member (NACWA) Michael E. Yates North County Labor Legislative Club Executive Board Member St. Louis Labor Council Delegate

Jan Zimmerman American Water Works Association Member Government Finance Officers Association Member National Association of Female Executives Member National Association of Professional Women Member Women in Public Finance Member

APPLICATION TO THE METROPOLITAN ST. LOUIS SEWER DISTRICT FOR CERTIFICATE OF QUALIFICATION TO BID

The undersigned hereby applies to the Executive Director of the Metropolitan St. Louis Sewer District for a Certificate of Qualification to bid the following types of work: (Check each type of work for which qualification is requested)

______Sewer Construction (Drain layers license required for City or County) Section V. A., Page 12 ______Deep Sewer Construction (Drain layers license required for City or County) Section V. B., Page 13 ______Building Construction Section V. C., Page 14 ______Natural Channel Restoration and Bio-Retention Section V. D., Page 15 ______Pipe and Manhole Rehabilitation Section V. E., Page 16 Cured-In-Place Pipe (CIPP) Section V. F, Page 17 & 18 Cured-In-Place Lateral Liner (CIPL) Section V. G, Page 19 & 20 ______Concrete Channels, Walls and Structures Section V. H., Page 21 ______Mechanical/Electrical/Plumbing Section V. I., Page 22 ______Tunneling/Trenchless Section V. J., Page 23 ______Demolition Section V. K., Page 24 – Refer to page 24 for explanation of Class I & II St. Louis County Demolition St. Louis City – Class I and II St. Louis City – Class II only

Note: Sewer Construction shall consist of sewer projects requiring excavation of approximately 20 feet or less in depth and which do not require significant involvement with urban type features such as utilities, structures, urban landscape, other features of an urban nature, or significant amounts of classified excavation. Deep Sewer Construction shall consist of sewer projects requiring excavation of greater than approximately 20 feet in depth and/or that requires significant involvement with trench bracing or urban type features, or significant amounts of classified excavation. The District shall be the sole judge as to the type of construction each project falls under.

TYPE OF ORGANIZATION (Check Applicable Category) ______Corporation ______Partnership ______Sole Proprietorship ______Joint Venture ______(Firm Name) ______(Firm Address)

______(Firm City, State, Zip Code) By ______Title ______(Signature) THE SIGNATORY OF THIS QUESTIONNAIRE GUARANTEES THE TRUTH AND ACCURACY OF ALL STATEMENTS AND OF ALL ANSWERS TO INTERROGATORIES HEREINAFTER MADE Please list any previous experience or projects your company has completed for each category you are requesting approval for, and any references you can provide. Name of Contractor ______Principal Address ______( ) A corporation ( ) A general co-partnership ( ) A limited co-partnership ( ) An individual ( ) Joint Venture ( ) MWBE (Minority or Woman Business Enterprise) If MWBE, what is the name of the agency/organization that issued the certification document? ______Please attach a copy of your certification document to this application. Incorporated or organized: Date ______State ______Radius of operations: ______Type of work done: ______Work usually sublet: Name of Bonding Company ______Total Bonding Capacity of Firm $______

I. How many years have you operated under the above name: (a) As general contractor ______(b) As subcontractor ______II. List other names under which you have operated: Name of company ______Type of work done ______Operated during period ______Name of company ______Type of work done ______Operated during period ______

III. List of all partners or officers: (Note: if partnership limited, explain and please list full 100% ownership) Name and title______Address, City and State______Fractional interest in firm or number of shares owned______

Name and title______Address, City and State______Fractional interest in firm or number of shares owned ______

Name and title ______Address, City and State______Fractional interest in firm or number of shares owned ______

IV. What is the construction experience of the principal individuals of your organization? (This includes the job superintendent). An individual’s name

Present position or office

Years of construction experience

Magnitude and type of work

An individual’s name

V. List all experience for the past five years in the following categories for which you want to qualify. SECTION A. - Sewer Construction (See definition on page 9) (Includes storm sewer, sanitary sewers, and small pump stations) 1. Contract Amount ______When Completed ______Type of Project______Pipe size and length laid______Location of Project

Name, Address & Phone Number of Owner ______

2. Contract Amount ______When Completed ______Type of Project______Pipe size and length laid______Location of Project______Name, Address & Phone Number of Owner ______

3. Contract Amount ______When Completed ______Type of Project______Pipe size and length laid______Location of Project______Name, Address & Phone Number of Owner ______

4. Contract Amount ______When Completed ______Type of Project______Pipe size and length laid______Location of Project______SECTION V. A. Sewer Construction Page 14 rev 11/21/13 Name, Address & Phone Number of Owner ______

SECTION V. A. Sewer Construction Page 15 rev 11/21/13 List all experience for the past five years in the following categories for which you want to qualify. SECTION B. - Deep Sewer Construction (See definition Page 9) (Includes sanitary sewer, storm sewer, and small pump stations) 1. Contract Amount ______When Completed______Type of Project______Pipe size, average depth and length laid______Location of Project______Name, Address & Phone Number of Owner ______

2. Contract Amount ______When Completed______Type of Project______Pipe size, average depth and length laid

Location of Project______Name, Address & Phone Number of Owner ______

3. Contract Amount ______When Completed ______Type of Project______Pipe size, average depth and length laid

Location of Project______Name, Address & Phone Number of Owner ______

4. Contract Amount ______When Completed______Type of Project______Pipe size, average depth and length laid

SECTION V. B. Deep Sewer Construction Page 16 rev 11/21/13 Location of Project______Name, Address & Phone Number of Owner ______

SECTION V. B. Deep Sewer Construction Page 17 rev 11/21/13 List all experience for the past five years in the following categories for which you want to qualify. SECTION C - Building Construction (Includes large pump stations, treatment plants, and operational facilities)

1. Contract Amount ______When Completed ______Type of Project ______Location of Project ______Name, Address & Phone Number of Owner ______

2. Contract Amount ______When Completed ______Type of Project ______Location of Project______Name, Address & Phone Number of Owner______

SECTION V. C. Building Construction Page 18 rev 11/21/13 5. Contract Amount ______When Completed ______Type of Project ______Location of Project ______Name, Address & Phone Number of Owner______

SECTION V. C. Building Construction Page 19 rev 11/21/13 List all experience for the past five years in the following categories for which you want to qualify. SECTION D. Natural Channel Restoration and Bio-Retention (Includes hard-armoring, permanent BMP’s and landscaping) 1. Contract Amount ______When Completed Type of Project ______Location of Project ______Name, Address & Phone Number of Owner ______

2. Contract Amount ______When Completed ______Type of Project______Location of Project______Name, Address & Phone Number of Owner______

3. Contract Amount ______When Completed ______Type of Project ______Location of Project______Name, Address & Phone Number of Owner

SECTION V.D. Natural Channel Restoration And Bio-Retention Page 20 rev 11/21/13 5. Contract Amount ______When Completed ______Type of Project______Location of Project ______Name, Address & Phone Number of Owner ______

SECTION V.D. Natural Channel Restoration And Bio-Retention Page 21 rev 11/21/13 List all experience for the past five years in the following categories for which you want to qualify. SECTION E. - Pipe and Manhole Rehabilitation (Give pipe sizes) (Includes point repair, pipe bursting, slip lining, etc.) 1. Contract Amount ______When Completed Type of Project ______Location of Project______Name, Address & Phone Number of Owner______

3. Contract Amount ______When Completed ______Type of Project ______Location of Project______Name, Address & Phone Number of Owner

SECTION V. E. Pipe and Manhole Rehabilitation Page 22 rev 11/21/13 5. Contract Amount ______When Completed ______Type of Project ______Location of Project______Name, Address & Phone Number of Owner______

SECTION V. E. Pipe and Manhole Rehabilitation Page 23 rev 11/21/13 List all experience for the past five years in the following categories for which you want to qualify. SECTION F. – Cured-in-Place Pipe (CIPP) Statement of Qualifications for Cured-in-Place Pipe

1. Project Name: ______Contract Amount ______When Completed

Manufacturer of CIPP product ______Trade Name of CIPP product ______Component materials of CIPP (i.e. non-woven polyester felt tube and epoxy vinyl ester resin) ______Installation Method: Invert: _____ Pull-In: _____ Installed Pipe Length: _____ Pipe Sizes: _____ Pipe Type: Gravity ____ Pressure ______Project Owner: ______Contact Name: ______Contact No.:______Relevant ASTM Specification: ASTM F-1216____ ASTM F-1743 ____ Other (please specify) ______Lowest 3rd Party D790 Testing Results on Project: Flexural Strength ______Flexural Modulus ______Tensile Strength ______(only applicable for pressure pipe) 2. Project Name: ______Contract Amount ______When Completed

Manufacturer of CIPP product ______Trade Name of CIPP product ______Component materials of CIPP (i.e. non-woven polyester felt tube and epoxy vinyl ester resin) ______Installation Method: Invert: _____ Pull-In: _____ Length of Pipe Installed: ______Pipe Size: ______Pipe Type: Gravity ______Pressure ______Project Owner: ______Contact Name: ______Contact No.:______Relevant ASTM Specification: ASTM F-1216____ ASTM F-1743 ____ Other (please specify) ______Lowest 3rd Party D790 Testing Results on Project:

SECTION V. F. Cured-in-Place Pipe Page 24 rev 11/21/13 Flexural Strength ______Flexural Modulus ______Tensile Strength ______(only applicable for pressure pipe) SECTION F. – Cured-in-Place Pipe (CIPP) Statement of Qualifications for Cured-in-Place Pipe

Manufacturer of CIPP product ______Trade Name of CIPP product ______Component materials of CIPP (i.e. non-woven polyester felt tube and epoxy vinyl ester resin) ______Installation Method: Invert: _____ Pull-In: _____ Length of Pipe Installed: ______Pipe Size: ______Pipe Type: Gravity ______Pressure ______Project Owner: ______Contact Name: ______Contact No.:______Relevant ASTM Specification: ASTM F-1216____ ASTM F-1743 ____ Other (please specify) ______Lowest 3rd Party D790 Testing Results on Project: Flexural Strength ______Flexural Modulus ______Tensile Strength ______(only applicable for pressure pipe)

Manufacturer of CIPP product ______Trade Name of CIPP product ______Component materials of CIPP (i.e. non-woven polyester felt tube and epoxy vinyl ester resin) ______Installation Method: Invert: _____ Pull-In: _____ Length of Pipe Installed: ______Pipe Size: ______Pipe Type: Gravity ______Pressure ______Project Owner: ______Contact Name: ______Contact No.:______Relevant ASTM Specification:

SECTION V. F. Cured-in-Place Pipe Page 25 rev 11/21/13 ASTM F-1216____ ASTM F-1743 ____ Other (please specify) ______Lowest 3rd Party D790 Testing Results on Project: Flexural Strength ______Flexural Modulus ______Tensile Strength ______(only applicable for pressure pipe)

SECTION V. F. Cured-in-Place Pipe Page 26 rev 11/21/13 List all experience for the past five years in the following categories for which you want to qualify. SECTION G. – Cured in Place Lateral Lining (CIPL) Statement of Qualifications for cured-in-place lateral lining (includes cured-in-place lateral connection repairs).

Manufacturer of CIPL product ______Trade Name of CIPL product ______Component materials of CIPL (i.e. non-woven polyester felt tube and epoxy vinyl ester resin) ______No. of Laterals Lined: ______Total Length of Laterals Lined: ______Manufacturer of Water Tight Seal (waterstop): ______Manufacturer of Lateral Connection Repair (LCR): ______(Attach written documentation from manufacturer certifying that contractor is an approved installer of their product). No. of LCR’s Installed: ______Project Owner: ______Contact Name: ______Contact No.:______Relevant ASTM Specification: Lowest Value of 3rd Party D790 Testing Results on Project: Flexural Strength ______Flexural Modulus ______

Manufacturer of CIPL product ______Trade Name of CIPL product ______Component materials of CIPL (i.e. non-woven polyester felt tube and epoxy vinyl ester resin) ______No. of Laterals Lined: ______Total Length of Laterals Lined: ______Manufacturer of Water Tight Seal (waterstop): ______Manufacturer of Lateral Connection Repair (LCR): ______(Attach written documentation from manufacturer certifying that contractor is an approved installer of their product). No. of LCR’s Installed: ______Project Owner: ______Contact Name: ______Contact No.:______Relevant ASTM Specification: SECTION V. G. Cured-in-Place Lateral Liner Page 27 rev 11/21/13 Lowest Value of 3rd Party D790 Testing Results on Project: Flexural Strength ______Flexural Modulus ______SECTION G. – Cured in Place Lateral Lining (CIPL) Statement of Qualifications for cured-in-place lateral lining (includes cured-in-place lateral connection repairs).

Manufacturer of CIPL product ______Trade Name of CIPL product ______Component materials of CIPL (i.e. non-woven polyester felt tube and epoxy vinyl ester resin) ______No. of Laterals Lined: ______Total Length of Laterals Lined: ______Manufacturer of Water Tight Seal (waterstop): ______Manufacturer of Lateral Connection Repair (LCR): ______(Attach written documentation from manufacturer certifying that contractor is an approved installer of their product). No. of LCR’s Installed: ______Project Owner: ______Contact Name: ______Contact No.:______Relevant ASTM Specification: Lowest Value of 3rd Party D790 Testing Results on Project: Flexural Strength ______Flexural Modulus ______

Manufacturer of CIPL product ______Trade Name of CIPL product ______Component materials of CIPL (i.e. non-woven polyester felt tube and epoxy vinyl ester resin) ______No. of Laterals Lined: ______Total Length of Laterals Lined: ______Manufacturer of Water Tight Seal (waterstop): ______Manufacturer of Lateral Connection Repair (LCR): ______(Attach written documentation from manufacturer certifying that contractor is an approved installer of their product). No. of LCR’s Installed: ______SECTION V. G. Cured-in-Place Lateral Liner Page 28 rev 11/21/13 Project Owner: ______Contact Name: ______Contact No.:______Relevant ASTM Specification: Lowest Value of 3rd Party D790 Testing Results on Project: Flexural Strength ______Flexural Modulus ______

SECTION V. G. Cured-in-Place Lateral Liner Page 29 rev 11/21/13 List all experience for the past five years in the following categories for which you want to qualify. SECTION H. - Concrete Channels, Walls & Structures 1. Contract Amount ______

When Completed ______Type of Project______Location of Project______Name, Address & Phone Number of Owner______

SECTION V.H. - Concrete Channels, Walls, & Structures Page 30 rev 11/21/13 5. Contract Amount ______When Completed ______Type of Project ______Location of Project______Name, Address & Phone Number of Owner ______

SECTION V.H. - Concrete Channels, Walls, & Structures Page 31 rev 11/21/13 List all experience for the past five years in the following categories for which you want to qualify. SECTION I. - Mechanical/Electrical/Plumbing

SECTION V.I. Mechanical/Electrical/Plumbing Page 32 rev 11/21/13 5. Contract Amount ______When Completed ______Type of Project ______Location of Project______Name, Address & Phone Number of Owner ______

SECTION V.I. Mechanical/Electrical/Plumbing Page 33 rev 11/21/13 List all experience for the past five years in the following categories for which you want to qualify. SECTION J. – Tunneling/Trenchless

1. Contract Amount ______When Completed ______Type of Project______Location of Project ______Name, Address & Phone Number of Owner______

3. Contract Amount ______When Completed ______Type of Project______Location of Project______Name, Address & Phone Number of Owner ______

SECTION V. J. – Tunneling/Trenchless Page 34 rev 11/21/13 5. Contract Amount ______When Completed ______Type of Project ______Location of Project______Name, Address & Phone Number of Owner ______

SECTION V. J. – Tunneling/Trenchless Page 35 rev 11/21/13 List all experience for the past five years in the following categories for which you want to qualify. SECTION K. – Demolition Demolition work for MSD within the City of St. Louis–attach certification for specific classification. Class I–no building size restrictions. .Class II -limited to buildings under 3 stories/50 feet high/50,000 square feet area/200,000 cubic feet volume. .Buildings under 1 ½ stories/10,000 cubic feet volume, with no basement, require no demolition license. St. Louis County – does not require license. 1. Contract Amount ______When Completed ______Type of Project ______Location of Project ______Name, Address & Phone Number of Owner______2. Contract Amount ______When Completed ______Type of Project______Location of Project______Name, Address & Phone Number of Owner______

3. Contract Amount ______When Completed ______Type of Project______Location of Project______Name, Address & Phone Number of Owner______4. Contract Amount ______When Completed ______Type of Project______Location of Project______Name, Address & Phone Number of Owner______

SECTION V K. Demolition Page 36 rev 11/21/13 5. Contract Amount ______When Completed ______Type of Project ______Location of Project______Name, Address & Phone Number of Owner ______

SECTION V K. Demolition Page 37 rev 11/21/13 List all experience for the past five years in the following categories for which you want to qualify. VI. What Sewer or Building projects is your organization now in process of constructing? 1. Contract Amount ______

Scheduled Completion Date ______Type of Project______Location of Project______Name, Address & Phone Number of Owner______

2. Contract Amount ______Scheduled Completion Date ______Type of Project______Location of Project______Name, Address & Phone Number of Owner______

3. Contract Amount ______

Scheduled Completion Date ______Type of Project______Location of Project______Name, Address & Phone Number of Owner______

4. Contract Amount ______Scheduled Completion Date ______Type of Project______Location of Project______Name, Address & Phone Number of Owner______NOTE: If more space is needed, attach additional sheets.

SECTION V I. & VII. Page 38 rev 11/21/13 VII. Have you ever failed to complete any work awarded to you? (If so, explain) ______

SECTION V I. & VII. Page 39 rev 11/21/13 EQUIPMENT (What equipment do you own that is available for proposed work?)

QUANTITY ITEM DESCRIPTION, SIZE, EQUIP CONDITION YEARS PRESENT CAPACITY, ETC HOURS OF LOCATION SERVICE

* Condition shall be graded as follows: New under 12 months Over 12 months old Rebuilt N-1 0-1(Good) R-1 0-2(Average) R-2 0-3(Fair) R-3 0-4(Poor) R-4 (Poor)

rev 11/21/13 SECTION - Equipment AFFIDAVIT FOR INDIVIDUAL

State of ______) ) ss. County of ______)

______, being duly sworn, deposes and says that the answers to the foregoing interrogatories are true, and that any depository, vendor or other agency herein named is authorized to supply The Metropolitan St. Louis Sewer District with any information necessary to verify this statement.

______(Applicant sign here)

Sworn to before me, this ______day of ______, 20 _____.

______Notary Public

(seal)

AFFIDAVIT FOR CO-PARTNERSHIP

______, being duly sworn, deposes and says that they are a member of the firm of ______that they are familiar with the books of said firm showing its financial condition; and that the answers to the foregoing interrogatories are true, and that any depository, vendor or other agency herein named is authorized to supply The Metropolitan St. Louis Sewer District with any information necessary to verify this statement.

______

______(Members of firm, sign above)

Sworn to before me, this ______day of ______, 20____.

______Notary Public (seal) AFFIDAVIT FOR CORPORATION

______, being duly sworn, deposes and says that ___he is ______of the ______the corporation described in and which executed the foregoing statement that ____he is familiar with the books of the said corporation, showing its financial condition; and that the answers of the foregoing interrogatories are true, and that any depository, vendor or other agency herein named is authorized to supply The Metropolitan St. Louis Sewer District with any information necessary to verify this statement. ______

______Title ______Title

Sworn to before me, this ______day of ______, 20 ______.

______Notary Public (seal)