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