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
TUNNELING PRE-QUALIFICATION QUESTIONNAIRE
Maline Creek CSO BP 051 & 052
Local Storage Facility
Project Number: 11656
___________________________________________________________
SUBMITTED BY (COMPANY)
___________________________________________________________
ADDRESS
___________________________________________________________
CITY, STATE, ZIP CODE
___________________________________________________________
DATE
___________________________________________________________
CONTACT NAME (FOR QUESTIONS) - TELEPHONE & FAX
TAX ID NUMBER
_____________________________________________________________
E-MAIL ADDRESS
Page 1 of 31
Rev. 9/21/2015
Maline Creek CSO BP 051 & 052
Local Storage Facility
Project Number: 11656
Scope of Work
The Maline Creek CSO BP 051 & 052 Local Storage Facility is to be a combined sewer
overflow (CSO) facility located in the northern part of the City of St. Louis within the Bissell
Point Service Area. The facility will collect CSO from three outfalls, store it in a deep cavern,
and then pump it for discharge into the existing North Bissell tunnel.
Key components of the Maline Creek CSO Storage Facility are:









a centrally-located, 40-ft finished diameter, 12.5 million gallons per day (MGD)
submersible pump station,
a 60-ft long x 28-ft finished diameter adit extending from the pump station to the cavern,
a 28-ft finished diameter cavern extending 1,824-ft in the southerly direction and 884-ft
in the northerly direction from the pump station adit,
a 600-ft long x 6-ft lined connecting tunnel,
three deaeration chambers,
three intake structures, including modifications of their associated, existing large
diameter sewers,
a shallow connector sewer, constructed as a micro tunnel extending from the dry weather
interceptor to a drop structure at the existing North Bissell Tunnel,
miscellaneous small diameter storm sewers and inlets, and
electrical, mechanical, instrumentation and control, structural, and architectural work
associated with the pump station and intake structures.
The cavern, connecting tunnel, and deaeration chambers will be constructed at a depth of 100 to
180 feet below ground surface in limestone and dolomite bedrock. The pump station shaft and
the various drop and vent shafts at the intake structures will be constructed through soil
overlying the bedrock.
Page 2 of 31
Rev. 9/21/2015
PREQUALIFICATION CHECK LIST
Below is a checklist of required documentation
 Signed Conflict of Interest Statement (Page 6)
 Signed Application Form (Page 10)
 Completed Qualification Questionnaire (Page 11 through 17)
 Hard Rock Tunnel Projects Sheet is complete (Page 18)
 Slurry Wall and/or Secant Pile Projects Sheet is complete (Page 19)
 Current Projects over $10 million Sheet is completed (Page 20)
 List of all Rock Tunneling Equipment Sheet is completed (Page 21)
 Bonding capacity indicated (Page 22)
 Provide a copy of your company’s Experience Modification Rating (EMR) from your
workers’ compensation insurance carrier (Page 22)
 Letter from insurance carrier affirming contractor’s ability to obtain the insurance coverage.
(Pages 26 – 28)
 Affidavit is complete with Notary Seal (Page 29, 30, or 31), whichever is applicable
 Attach Certificate from the Secretary of State showing company is authorized to transact
business in the State of Missouri
Page 3 of 31
Rev. 9/21/2015
RULES AND REGULATIONS FOR PREQUALIFICATION OF CONTRACTORS
ON WORK LET BY CONTRACT WITH
THE METROPOLITAN ST. LOUIS SEWER DISTRICT
1. All applicants wishing to bid on the Maline Creek CSO BP 051 & 052 Local Storage
Facility, Project Number 11656, must be prequalified to bid on this specific project. This
Prequalification is valid only for the referenced project.
2. 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 Prequalification Questionnaire.
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. No bidder will be pre-qualified unless its Pre-qualification Questionnaire indicates that it has
the experience, organization, currently available resources, and equipment, sufficient in the
judgment of the District, to satisfactorily execute its contract and meet its obligations therein
incurred.
5. The Financial Statement of the controlling individual or corporate owner of the business, or
businesses in the case of a joint venture, shall be submitted; if in the opinion of the District it
is required.
6. If any significant change occurs in the information included on the contractor’s prequalification form, notice shall be given to the District immediately.
7. All entities must furnish a certificate from the Secretary of State showing that it is authorized
to transact business in the State of Missouri.
8. Letter from insurance carrier affirming contractor’s ability to obtain the insurance coverage.
9. Attach resumes of principle team members of your field superintendence team.
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 the applicant subcontracts to others.
Page 4 of 31
Rev. 9/21/2015
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 Plan Room located at URL: www.stlmsdplanroom.com. Plans and specifications are also
available for viewing or purchase at Cross Rhodes Reprographics located at 1710 Macklind
Avenue, St Louis MO 63110.
2. 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.
3. MINORITY AND WOMEN BUSINESS ENTERPRISE UTLIZATION AND WORKFORCE
PROGRAMS
The Metropolitan St. Louis Sewer District has established a goal for Minority Business Enterprises
(MBE) and Women Business Enterprises (WBE) utilization for construction contracts. Additional
workforce requirements also apply. These requirements are explained in the MWBE Utilization
and Workforce Program Non-Building Construction Projects. Please refer to the following link to
view a pdf of this policy:
http://www.stlmsd.com/sites/default/files/misc/Non-Building%20Construction%20Projects%20%20MWBE%20Utilization%20and%20Workforce%20Program%20%20August%205%2C%202015.pdf
4. 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.
5. RIGHT TO REJECT
The Metropolitan St. Louis Sewer District reserves the right to reject any and all bids and to waive
technicalities.
6. PREQUALIFICATION DUE DATE
In order to be considered for pre-qualification for the Maline Creek CSO BP 051 & 052 Local
Storage Facility, Project Number: 11656 all pre-qualification questionnaires must be received by
the District no later than December 4, 2015 at 4:00 p.m. CST.
Page 5 of 31
Rev. 9/21/2015
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 named in No. 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):
3.
In the past two (2) years, has the individual or company named in No. 1 above done
business with any person listed in Attachment A 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:
Signature:
Page 6 of 31
Rev. 9/21/2015
ATTACHMENT A
Updated September 15, 2015
NOTE: Attachment "A" contains a list of the MSD Trustees and their respective employer, MSD officers and Directors,
and the organizations which each are individually associated with, as applicable.
Trustee/Director
MSD BOARD OF TRUSTEES
Name of Firm, Organization or Company
Affiliation
American Public Works Association
American Society of Civil Engineers
Circle Club of St. Louis
Engineer’s Club of St. Louis
Engineers Without Borders
Huntbridge Forest Subdivision
Manchester UMC Board of Trustees
Masonic Lodge of Missouri
Missouri Athletic Club
Missouri Botanical Garden
Missouri Society of Professional Engineers
Missouri University of Science & Technology
Missouri University of Science & Technology Academy of
Civil Engineers
Missouri University of Science & Technology Academy of
Miner Athletics
Missouri University of Science & Technology Alumni
Association
Moolah Shrine Temple
Professional Training for Engineers, LLC
Racquet Ruckus Foundation
Reserve Officers Association
Royal Order of Jesters
Scottish Rite Bodies
U.S. Army Reserves, Retired
Water Environment Federation
Member
Member
Member
Member
Member
Secretary
Member
Member
Member
Member
Member
Adjunct Professor
Member
Ruby L. Bonner
Alpha Kappa Alpha Sorority, Inc.
Ethel Hedgeman Lyle Foundation
Mercy Seat Metropolitan Baptist Church
Missouri Bar Association
Mound City Bar Association
NAACP
National Bar Association
National Retired Teachers Association
Member
Member
Member
Member
Member
Member
Member
Member
James Faul
Lawyers Coordinating Committee
Missouri Bar Association
Missouri Jobs with Justice
St. Louis Botanical Gardens
St. Louis City Labor Legislative Club
St. Margaret of Scotland Catholic Church
St. Louis Zoo
Member
Member
Member
Member
Member
Member
Member
Robert T. Berry
Page 7 of 31
Member
Member, Executive
Committee
Member
President
Chairman
Member
Member
Member
Retired Officer
Member
Rev. 9/21/2015
MSD BOARD OF TRUSTEES
Name of Firm, Organization or Company
Affiliation
Brian Hoelscher
Engineers Club of St. Louis
Missouri Water Environment Association
National Association of Cleanwater Agencies (NACWA)
Project MOSAIC
Washington University in St. Louis - W Club
Water Environment Federation
Committee Member
Member
Member
Ambassador
Executive Council
Member
Annette K. Mandel
Central West End Planning & Development Committee
Missouri Athletic Club
Missouri Bar Association
Missouri Botanical Gardens
Missouri History Museum
St. Louis Zoo
USO Missouri
Member
Member
Member
Member
Member
Member
Volunteer
Barbara Mohn
Water Wastewater CIO Forum
Women Executives in IT (WEIT)
Member
Member
Susan M. Myers
Association of Corporate Counsel
Association of Missouri Cleanwater Agencies (AMCA)
Bar Association of Metropolitan St. Louis
Missouri Bar Association
National Association of Cleanwater Agencies (NACWA)
Member
Member
Member
Member
Member
Valerie Patton
Delta Sigma Theta Sorority, Inc.
Guardian Angels Settlement Association
Howard University Alumni Club of St. Louis
INROADS Missouri Midwest
National Association of Social Workers
Professional Organization of Women St. Louis
United Way of Greater St. Louis
Member
Board Member
Member
Board Member
Member
Board Member
Board Member.
Corporate Secretary
Board Member,
Leadership Council
Board Member
Trustee/Director
University of Missouri-St. Louis - College of Business
Administration
Washington University in St. Louis - Alumni Board of
Governors
Betsy Schubert
Institute for Supply Management
Member
Timothy R. Snoke
Contractor Loan Fund
Government Finance Officers Association
Institute of Management Accountants
St. John's Lutheran Church
St. John's Lutheran School Board of Education
St. Louis Treasury Management Association
Board Member,
Executive Committee
Member
Member
Member
Chair
Member
American Water Works Association (AWWA)
Engineers Club of St. Louis
Missouri Water Environment
National Association of Clean Water Agencies (NACWA)
Member
Member
Member
Member
Jonathon Sprague
Page 8 of 31
Rev. 9/21/2015
MSD BOARD OF TRUSTEES
Name of Firm, Organization or Company
Affiliation
Water Environment Federation
Member
Vicki Taylor-Edwards
AAIM Management Association
Alpha Kappa Alpha Sorority
Certified Employee Benefits Association
Compensation Benefits Network
Human Resources Management Association
International Public Management Association
Shalom City of Peace
Member
Member
Member
Member
Member
Member
Member
Rich L. Unverferth
Engineers Club of St. Louis
Knights of Columbus - Council 2119 Webster Groves
National Association of Clean Water Agencies (NACWA)
St. Michael the Archangel Catholic Parish
Member
Member
Member
Member
Michael E. Yates
North County Labor Legislative Club
Executive Board
Member
Delegate
Trustee/Director
St. Louis Labor Council
Page 9 of 31
Rev. 9/21/2015
Application to the Metropolitan St. Louis Sewer District for
Prequalification to Bid
The undersigned hereby applies to the Metropolitan St. Louis Sewer District for Prequalification to bid
the Maline Creek CSO BP 051 & 052 Local Storage Facility (Project Number 11656).
Firm Name
Firm Address
By
Title
Print name
Signature
Type of Organization (Check Applicable Category)
□
Corporation
□
Partnership
□
Joint Venture
□
Sole Proprietorship
Corporate Seal
Page 10 of 31
Rev. 9/21/2015
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 as requested on the
following sheets and any references you can provide. Attach additional sheets if necessary.
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:
1. How many years have you operated under the above name:
(a) As general contractor
(b) As subcontractor
2. List other names under which you have operated:
Name of company
Type of work done
Operated during period
Name of company
Page 11 of 31
Rev. 9/21/2015
Type of work done
Operated during period
3.
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
4.
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
Present position or office
Years of construction experience
Magnitude and type of work
Page 12 of 31
Rev. 9/21/2015
An individual’s name
Present position or office
Years of construction experience
Magnitude and type of work
5.
Name the principal team members of your Field Superintendence team if awarded the
contract, summarize their experience here and attach their resumes:
Individual’s name:
Intended position:
Present position:
Years of field construction experience:
Magnitude and type of work:
Individual’s name:
Intended position:
Present position:
Years of field construction experience:
Magnitude and type of work:
Individual’s name:
Intended position:
Present position:
Years of field construction experience:
Magnitude and type of work:
Page 13 of 31
Rev. 9/21/2015
Individual’s name:
Intended position:
Present position:
Years of field construction experience:
Magnitude and type of work:
Individual’s name:
Intended position:
Present position:
Years of field construction experience:
Magnitude and type of work:
Page 14 of 31
Rev. 9/21/2015
6.
Describe at least three similar projects since 2005 that your organization has completed
or are currently working on with the following characteristics:
 Construction of tunnel in rock over 3,000 feet in length.
 Construction of tunnel in rock by drill and blast methods with finished
diameter of 20 feet or larger.
 Construction and excavation of shafts over 100 feet deep and over 30 feet in
diameter in rock.
 Construction and excavation of shafts over 100 feet deep and over 30 feet in
diameter in overburden.
 Experience in cut-off and consolidation grouting from the surface and from
within the tunnel.
 Construction of shaft over 30 feet in diameter using the slurry wall method
and/or the secant pile method.
The descriptions should also include the contract amount, start and completion dates and
names, addresses and phone numbers for Owner and Engineer contacts. The information
shall clearly indicate which of these major components were self-performed and which were
subcontracted. Joint venture firms must provide information on at least three projects
completed by each partner company.
(1)
Project Name:
Owner Name (Company and Individual Contact):
Owner Phone Number:
Owner E-mail:
Engineer Name (Company and Individual Contact):
Engineer Phone Number:
Engineer E-mail:
Dates Work Performed:
Project Description:
Page 15 of 31
Rev. 9/21/2015
(2)
Project Name:
Owner Name (Company and Individual Contact):
Owner Phone Number:
Owner E-mail:
Engineer Name (Company and Individual Contact) :
Engineer Phone Number:
Engineer E-mail:
Dates Worked Performed:
Project Description:
Page 16 of 31
Rev. 9/21/2015
(3)
Project Name:
Owner Name (Company and Individual Contact):
Owner Phone Number:
Owner E-mail:
Engineer Name (Company and Individual Contact) :
Engineer Phone Number:
Engineer E-mail:
Dates Work Performed:
Project Description:
Page 17 of 31
Rev. 9/21/2015
7.
Hard Rock Tunnel Projects Completed in Last Ten Years.
Contract Name
Lead
Contractor
Tunnel
Dia.
Length
Start
Date
Finish Date
Contract
Actual
Contract
Value
Notes
1. Only projects where the Prospective Bidder was the Tunnel Contractor will be considered.
2. For JVs, indicate which partner’s experience is being claimed.
Page 18 of 31
Engineer
Contact
Owner
Contact
Principal Features
Rev. 9/21/2015
8.
Slurry Wall and/or Secant Pile Projects Completed in Last Ten Years.
Contract Name
Lead
Contractor
Slurry Wall
Width
Length
Thick
-ness
Start
Date
Finish Date
Contract
Actual
Contract
Value
Engineer
Contact
Owner
Contact
Principal Features
Notes.
1. Identify if Slurry Wall work was completed by a subcontractor. If applicable name the subcontractor who performed the work.
2. For JVs, indicate which partner’s experience is being claimed
Page 19 of 31
Rev. 9/21/2015
9.
All Current Projects on Hand over $10 million
Contract Name
Lead
Contractor
For Tunnels
Dia.
Length
Start
Date
Finish Date
Contract
Forecast
Contract
Value
Engineer
Contact
Owner
Contact
Show all projects currently in progress that are valued over $10 million to the sole contractor or each JV partner
Page 20 of 31
Rev. 9/21/2015
Principal
Features
10.
Item
List all the rock tunnel equipment (e.g. drill and blast equipment, TBM’s, etc…) that you own.
Description, Size, Capacity, etc.
Quantity
Owner
Equip.
Hours
Years
Service
Condition*
Condition of Equipment is to be measured and coded as follows:
1. Under 12 months old:
New
N-1
2. Over 12 months old:
Good
Average
Fair
Poor
O-1
O-2
O-3
O-4
3. Rebuilt:
Page 21 of 31
Good
Average
Fair
Poor
R-1
R-2
R-3
R-4
Rev. 9/21/2015
Location
Date
Available
11.
Describe your Financial Capacity (and the financial capacities of JV partners if the
Applicant is a joint venture) and attach a copy of your latest Balance Sheet(s):
Amount of available line of credit and names of lending institution(s)
12.
What is your Bonding Capacity?
Name of Bonding Company:
Total Bonding Capacity: $
Amount of Bonding currently available $
13.
List your firm’s Experience Modification Rate (EMR) for each of the past three
premium years:
NOTE: An Experience Modification Rate is issued to your firm annually by your
workers’ compensation insurance carrier.
Current year:
Previous year:
Year prior to previous year:
If your EMR for any of these three years is or was 1.00 or higher you may, if you wish,
attach a letter of explanation.
(Provide verification of the current years EMR from your workers’ compensation
insurance carrier.)
Page 22 of 31
Rev. 9/21/2015
14.
Briefly describe any and all litigation resolved or initiated in the last 10 years in
which you (and each partner, if a JV) have been involved. Include the current
status:
15.
List, with an explanation, all projects in the last 10 years that you (and each partner,
if a JV) have failed to complete:
Page 23 of 31
Rev. 9/21/2015
Page 24 of 31
Rev. 9/21/2015
Metropolitan St. Louis
Sewer District
2350 Market Street
St. Louis, Missouri 63103
RE: Insurance Requirements for Annual Pre-Qualification
Metropolitan St Louis Sewer District (MSD) requires contractors to be prequalified prior to
bidding on Capital Improvement Projects. In the prequalification process, contractors must
demonstrate their ability to perform in the event they are awarded a contract, including meeting
the District’s insurance requirements.
MSD has certain contract requirements relating to contractor insurance coverage, including
increasing the limits for certain coverage and requiring pollution liability coverage. The District
recognizes that these additional coverage requirements impose additional costs upon contractors.
In an effort to alleviate any short term burden on contractors, for pre-qualification and bid
purposes only, MSD is willing to accept a letter signed by both the contractor and the
contractor’s insurance broker stating that the contractor has been approved for the additional
insurance coverage and that the contractor will obtain all required coverage and with the limits
required in the event a contract is awarded to the contractor. Further, the letter must state
affirmatively that the policy will be endorsed and coverage will be in place in the event a
contract is awarded. Additionally, the letter must state that in the event a contract is awarded and
insurance is not secured within the required timeframe, the contractor will forfeit its bid bond on
the project and will be determined non-responsive. These affirmative representations must be
repeated as part of any bid submitted by a contractor that does not have the required coverage in
place at the time of the bid.
Thank you for your cooperation in this matter.
Sincerely,
Betsy Schubert
Purchasing Manager
Page 25 of 31
Rev. 9/21/2015
Minimum Insurance Requirements
The following information is a draft of the minimum required insurance coverages that the
Metropolitan St. Louis Sewer will require for this project. Please provide a letter from your
insurance carrier affirming the applicant’s ability to obtain the minimum insurance coverage
as detailed below. The contract documents will include the complete insurance requirements for
this project.
The Contractor shall carry and maintain for the life of the contract adequate
insurance
for
commercial
general
liability,
(CGL)
workers’
compensation/employers liability and business auto liability, excess liability,
pollution liability and professional liability with a company satisfactory to the
Owner which is: (1) licensed to do business in the State of Missouri (Admitted)
with a financial strength rating of “A-” or better and a financial size category of
Class VI or higher per AMBest Company’s most recent edition or (2) not
licensed in the State of Missouri (Non-admitted) with a policyholder’s rating of
“A” or better and a financial size category of Class IX or higher in AMBest
Company’s most recent edition; (3) for Worker’s Compensation coverage only,
organized pursuant to the Missouri Insurance Company Act (R.S. Mo 287.900 to
287.920).
The insurance carrier will be acceptable regardless of the above requirements if
the insurance company furnishes a bond guarantee or policy containing a
provision (commonly referred to as a “cut-thru” endorsement) giving all claimants
thereunder a direct right of recovery against the company’s reinsurer, provided the
reinsurer meets one of the qualifications listed above.
Contractor’s Insurance
A. Worker’s Compensation:
1. Compensation:
Statutory Limits
2. Employer’s Liability:
$ 1,000,000 each accident
Coverage Limit:
$ 1,000,000 policy limit
Bodily Injury by Disease $ 1,000,000 each employee
B.
Commercial General Liability (occurrence form):
1. $ 1,000,000
per occurrence per project
2. $ 1,000,000
Products and Completed Operations Aggregate per project
3. $ 1,000,000
Personal and Advertising Injury
4. $ 1,000,000 General Aggregate per project or location
5. $ 10,000,000 Excess (Umbrella)
The following wording must be stated in the Description of Operations section of
the ISO Accord 255 form:
′No amendments to the ISO Commercial General Liability policy have been made
(with exception of: __________)
Page 26 of 31
Rev. 9/21/2015
The District’s status as an additional insured shall continue not only during the
time period in which the Contractor performs the work, but shall continue
thereafter for a period of two years after the date of acceptance of final payment.
An insurance policy will not be acceptable if any of the following coverages are
excluded from the ISO Commercial General Liability policy:
1. Premises – Operations Liability
2. Blanket Contractual Liability
3. Completed Operations Liability
4. Contractor’s Protective Liability (Independent Contractors)
5. Personal Injury Liability
6. Broad Form Property Damage Liability Endorsement
7. Coverage for explosion, collapse and underground hazards (X.C.U.)
8. Blasting [providing that blasting coverage may be excluded if blasting
is not to be performed in connection with the work.]
C.
Business Automobile Liability:
$ 1,000,000 Liability Coverage each occurrence:
$ 10,000,000 Excess (Umbrella)
$ 10,000,000 Aggregate per project
1. All owned vehicles, Non-owned and hired vehicles used in
conjunction with the work.
2. A MCS – 90 endorsement shall be included on the Business Auto
Liability Policy, if coverage for transportation is not included in the
Pollution Liability coverage.
D.
Pollution Liability:
1.
Contractor shall maintain in force for the full period of the Contract,
pollution liability insurance coverage for losses caused by sudden and
non-sudden pollution conditions that arise from the operations of the
successful bidder. Such insurance shall apply to bodily injury and
property damage, including loss of use of the damaged property or
property that has not been physically injured, transportation and nonowned disposal sites and shall cover cleanup, and defense costs, including
Page 27 of 31
Rev. 9/21/2015
all expenses incurred in the investigation, defense, payment or settlement
of claims.
2.
Pollution Liability Limits:
$10,000,000 per claim or per occurrence
$10,000,000 Aggregate Limit
3.
If pollution liability insurance is provided on a claims-made basis, the
successful bidder shall maintain the insurance in force of the full period of
the contract and two years after completion of the project.
Contractor shall maintain in force for the duration of this contract errors and omissions
liability insurance appropriate to the contractor profession. Coverage as required in this
Article shall apply to liability for professional error, act or omission arising out of scope
of the contractor services as defined in this contract. Coverage shall be written subject to
the limits of not less than
$10,000,000 Each Claim or Occurrence
$10,000,000 Aggregate Limit
The insurance coverage under such certificates shall be retroactive to the earlier of the
date of the contract or the commencement of the Contractor’s work on the Project, and
Contractor shall cause the same to remain in effect of a period of two (2) years after final
acceptance of the Project by the District (hereinafter referred to as the Insurance Period).
Page 28 of 31
Rev. 9/21/2015
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)
Page 29 of 31
Rev. 9/21/2015
AFFIDAVIT FOR CO-PARTNERSHIP
State of _____________________)
) ss.
County of ___________________)
___________________________________, 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)
Page 30 of 31
Rev. 9/21/2015
AFFIDAVIT FOR CORPORATION
State of ______________________)
) ss.
County of ____________________)
________________________________, 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)
Page 31 of 31
Rev. 9/21/2015