HomeMy Public PortalAboutPrequalification Application for Construction 2019THE METROPOLITAN ST
THE METROPOLITAN ST. LOUIS SEWER DISTRICT
2350 Market Street
St. Louis, MO 63103
Attn: Purchasing Department
Abby Meyer (314) 768-6250
or
Lisa Treat (314) 768-6269
CONSTRUCTION PRE-QUALIFICATION APPLICATION
For the Period of 9/1/19 thru 6/30/20
(USED IN PRE-QUALIFYING BIDDERS ON CAPITAL CONSTRUCTION WORK)
___________________________________________________________
SUBMITTED BY (COMPANY)
___________________________________________________________
ADDRESS
___________________________________________________________
CITY, STATE, ZIP CODE
___________________________________________________________
DATE
___________________________________________________________
CONTACT NAME (FOR QUESTIONS) - TELEPHONE& FAX
TAX ID NUMBER
_____________________________________________________________
E-MAIL ADDRESS FOR BID NOTICES
PREQUALIFICATION CHECK LIST
Below is a checklist of required documentation
Signed application and boxes checked indicating type of work requested – (Pages 9 and 10).
Signed Conflict of Interest Statement (Page 5).
Bonding capacity indicated (Page 10)
Equipment Sheet is complete (Page 30)
Affidavit is complete with Notary Seal for whichever type of business 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 (pages 31-36).
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.
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.
Supplier form (can be found here:
https://www.stlmsd.com/our-organization/purchasing/suppliershttps://www.stlmsd.com/our-organization/purchasing/suppliers). Please submit this with your package if you are a new bidder
or if you are an existing bidder and you have any changes to your contact information or company.
W-9
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 Prequalification Application.
2.A contractor must be prequalified prior to bid opening of a project.
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.Pre-qualification Application forms must be filed by September 1st of each year. 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 the following year.
No bidder will be pre-qualified unless its Pre-qualification Application 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.
The Financial Statement of the controlling individual or corporate owner of the business may be requested by MSD as part of the prequalification review. If requested by MSD the Financial
Statement shall be submitted or the review cannot be completed.
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.
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 a license.
NOTE: It is important that the work experience pages in Section V 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.
IMPORTANT INFORMATION FOR PROSPECTIVE BIDDERS
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
https://www.stlmsd.com/msd-work/bidding-projects/prequalification-informationhttps://www.stlmsd.com/msd-work/bidding-projects/prequalification-information Plans and specifications are
also available for viewing or purchase at Cross Rhodes Reprographics located at 2731 South Jefferson, St Louis, Missouri 63118.
PREQUALIFICATION
A contractor must be pre-qualified prior to bids being opened.
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.
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.
BID SECURITY
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.
RIGHT TO REJECT
The Metropolitan St. Louis Sewer District reserves the right to reject any and all bids and to waive technicalities.
VENDOR’S CONFLICT OF INTEREST STATEMENT
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).
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.
YesNo
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: _____
ATTACHMENT A
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.
Updated January 1, 2019
MSD BOARD OF TRUSTEES & DIRECTORS
Trustee/Director
Name of Firm, Organization or Company
Affiliation
Rev. Ronald Bobo, Sr.
Great Things, Inc. Foundation
Member
Trustee
NAACP
Member
Sharing Hope International Ministries
Member
St. Louis & Vicinity Baptist Ministers Union
Member
St. Louis Clergy Coalition
Member
West Side Missionary Baptist Church
Member
Bret A. Berthold
American Water Works Association (AWWA)
Member
Director
Engineers Club of St. Louis
Member
Missouri Water Environment
Member
National Association of Clean Water Agencies (NACWA)
Member
Water Environment Federation
Member
Tracey Coleman
Association for Talent Development
Member
Director
St. Elizabeth Mother of John the Baptist
Member
Society for Human Resource Management
Member
Freddie Dunlap
City of St. Louis Employee Retirement System
Trustee
Trustee
St. Louis Soldiers Memorial Military Museum
Commissioner
James Faul
Hartnett Gladney Hetterman, LLC
Partner
Trustee
Illinois Bar
Member
Lawyers Coordinating Committee
Member
Missouri Bar Association
Member
Missouri Jobs with Justice
Member
St. Louis Botanical Gardens
Member
St. Louis City Labor Legislative Club
Member
St. Margaret of Scotland Catholic Church
Member
St. Louis Zoo
Member
Marion M. Gee
American Water Works Association (AWWA)
Member
Director
Church on The Rock
Member
Government Finance Officers Association (GFOA)
Executive Board
Missouri Government Finance Officers Association
Member
Brian Hoelscher
Engineers Club of St. Louis
Member
Executive Director
Missouri Water Environment Association
Member
National Association of Cleanwater Agencies (NACWA)
Member
Project MOSAIC
Ambassador/Connector
Washington University in St. Louis - W Club
Executive Council
Water Environment Federation
Member
Annette K. Mandel
Central West End Planning & Development Committee
Member
Trustee
Missouri Athletic Club
Member
Missouri Bar Association
Member
Missouri Botanical Gardens
Member
Missouri History Museum
Member
St. Louis Zoo
Member
USO Missouri
Volunteer
Susan M. Myers
Association of Corporate Counsel
Member
Director
Association of Missouri Cleanwater Agencies (AMCA)
Member
Bar Association of Metropolitan St. Louis
Member
Missouri Bar Association
Member
Missouri Chamber of Commerce
Member
National Association of Cleanwater Agencies (NACWA)
Member
Betsy Schubert
Institute for Supply Management
Member
Manager
James I. Singer
AFL-CIO Lawyers Coordinating Committee
Member
Trustee
American Bar Association
Member
American College of Employee Benefit Counsel
Member
Bar Association of Metropolitan St. Louis
Member
Electricians Historical Society
Board member
Illinois Bar
Member
Missouri Bar
Member
Missouri Botanical Gardens
Member
Missouri Historical Society
Member
Schuchat, Cook and Werner
Partner
Shaare Emeth Congregation
Member
St. Louis University Law School
Adjunct Faculty
St. Louis Zoo
Member
Timothy R. Snoke
Contractor Loan Fund
Board Member, Executive Committee
Director
Government Finance Officers Association
Member
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 Water Works Association (AWWA)
Member
Director
Engineers Club of St. Louis
Member
Missouri Water Environment
Member
National Association of Clean Water Agencies (NACWA)
Member
Water Environment Federation
Member
Rich L. Unverferth
Engineers Club of St. Louis
Member
Director
Knights of Columbus - Council 2119 Webster Groves
Member
National Association of Clean Water Agencies (NACWA)
Member
St. Michael the Archangel Catholic Parish
Member
Michael E. Yates
North County Labor Legislative Club
Executive Board Member
Trustee
St. Louis Labor Council
Delegate
APPLICATION FOR CERTIFICATE OF QUALIFICATION TO BID
The undersigned hereby applies to 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
Section V. A., Page 13. Drain layers license required for City or County.
________Deep Sewer Construction
Section V. B., Page 15. Drain layers license required for City or County. To qualify in this category a contractor must demonstrate experience on multiple projects that are deemed complex
by the District. Typically a project would be considered complex when the installation of the pipe required excavation at depths greater than 20 feet for an extended length along
with one or more of the following addition construction challenges: significant involvement with trench bracing for urban type features; significant amounts of Class “A” or Class “B”
excavation; significant amount of poor soil conditions; significant length of large diameter pipe installation (36-inch or larger); or installation in locations having extremely limited
working room. The District shall be the sole judge as to whether a project is considered complex.
________Building Construction
Section V. C., Page 17
________Natural Channel Stabilization
Section V. D., Page 18
________Green Infrastructure and Bio-Retention
Section V. E., Page 19
________Pipe and Manhole Rehabilitation
Section V. F., Page 20
Cured-In-Place Pipe (CIPP)
Section V. G, Page 21 & 22
Cured-In-Place Lateral Liner (CIPL)
Section V. H, Page 23 & 24
________Concrete Channels, Walls and Structures
Section V. I., Page 25
________Mechanical/Electrical/Plumbing
Section V. J., Page 26
________Tunneling / Trenchless
Section V. K., Page 27
________Demolition
Section V. L., Pages 28 & 29 – Refer to page 28 for explanation of Class I & II
________ St. Louis County Demolition
________ St. Louis City – Class I and II
________ St. Louis City – Class II only
TYPE OF ORGANIZATION (Check Applicable Category)
_____ Corporation ______ Partnership ______ Joint Venture ______ Individual _________LLC
Firm Name: ________________________________Firm Address: ________________________
By ___________________________________Title _________________________
_________________________________
(Signature)
THE SIGNATORY OF THIS APPLICATION 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. Attach additional sheets
if necessary.
Name of Contractor_____________________________________________________
Principal Address_______________________________________________________
( )A corporation
( )A partnership
( )A joint venture
( )An individual
( )A limited liability corporation
( )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
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
V. Only list projects completed or in progress within the last five years in the categories for which you want to qualify. Attach additional sheets if necessary.
SECTION A. - Sewer Construction
(Includes storm sewer, sanitary sewers, and small pump stations)
1.Contract Amount__________________
When Completed or Percent Complete__________________
Project Description/Scope of Work: ____________________________________________
Pipe size and length laid_______________________________________________________
Location of Project
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
2.Contract Amount_________________
When Completed or Percent Complete __________________
Project Description/Scope of Work: ____________________________________________
Pipe size and length laid______________________________________________
Location of Project____________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner__________________________________________
3.Contract Amount__________________
When Completed or Percent Complete __________________
Project Description/Scope of Work: _____________________________________________
Pipe size and length laid______________________________________________
Location of Project____________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
4.Contract Amount___________________________________________________________
When Completed or Percent Complete __________________________________________
Project Description/Scope of Work: _____________________________________________
Pipe size and length laid_______________________________________________________
Location of Project___________________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
SECTION B. - Deep Sewer Construction (See definition Page 9)
(Includes sanitary sewer, storm sewer, and small pump stations)
1.Contract Amount ____________________________________________________________
When Completed or Percent Complete____________________________________________
Project Description/Scope of Work: _____________________________________________
Pipe size, average depth and length laid___________________________________________
What was complex about this project? ___________________________________________
__________________________________________________________________________
Location of Project___________________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
2.Contract Amount___________________________________________________________
When Completed or Percent Complete ___________________________________________
Project Description/Scope of Work: _____________________________________________
Pipe size, average depth and length laid ______
What was complex about this project? ___________________________________________
__________________________________________________________________________
Location of Project___________________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
3.Contract Amount___________________________________________________________
When Completed or Percent Complete_______________________________
Project Description/Scope of Work: _____________________________________________
Pipe size, average depth and length laid ______
What was complex about this project? ___________________________________________
__________________________________________________________________________
Location of Project___________________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
4. Contract Amount___________________________________________________________
When Completed or Percent Complete ___________________________________________
Project Description/Scope of Work: _____________________________________________
Pipe size, average depth and length laid ______
What was complex about this project? ___________________________________________
__________________________________________________________________________
Location of Project___________________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
List all experience for the past five years in the categories for which you want to qualify. List projects that are completed or in progress, attach additional sheets if necessary.
SECTION C - Building Construction
(Includes large pump stations, treatment plants, and operational facilities)
1.Contract Amount___________________________________________________________
When Completed or Percent Complete___________________________________________
Project Description/Scope of Work: _____________________________________________
Location of Project __________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone Number of Owner _______________________________________
2.Contract Amount__________________
When Completed or Percent Complete __________________________________________
Project Description/Scope of Work: ____________________________________________
Location of Project__________________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
3.Contract Amount__________________
When Completed or Percent Complete __________________
Project Description/Scope of Work: _____________________________________________
Location of Project___________________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner____________________________________________
4.Contract Amount___________________________________________________________
When Completed or Percent Complete __________________________________________
Project Description/Scope of Work: _____________________________________________
Location of Project___________________________________________________________
Name, Address & Phone # of Owner_____________________________________________
List all experience for the past five years in the categories for which you want to qualify. List projects that are completed or in progress, attach additional sheets if necessary.
SECTION D.Natural Channel Stabilization:
1.Contract Amount_____________ When Completed or Percent Complete
Project Description/Scope of Work: _____________________________________________
Specify channel stabilization methods installed: ____________________________________
Location of Project________________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
2.Contract Amount_____________When Completed or Percent Complete _______________
Project Description/Scope of Work: _____________________________________________
Specify channel stabilization methods installed: ___________________________________
Location of Project___________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of __________________________________________________
3.Contract Amount______________When Completed or Percent Complete ______________
Project Description/Scope of Work: _____________________________________________
Specify channel stabilization methods installed: ______________________________
Location of Project___________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner
4.Contract Amount______________When Completed or Percent Complete ______________
Project Description/Scope of Work: _____________________________________________
Specify channel stabilization methods installed: ____________________________________
Location of Project___________________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
List all experience for the past five years in the categories for which you want to qualify. List projects that are completed or in progress, attach additional sheets if necessary.
SECTION E.Green Infrastructure and Bio-Retention
1.Contract Amount____________When Completed or Percent Complete
Project Description/Scope of Work: _____________________________________________
Specify green infrastructure methods installed______________________________________
Location of Project________________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner____________________________________________
2.Contract Amount_______________When Completed or Percent Complete _____________
Project Description/Scope of Work: _____________________________________________
Specify green infrastructure methods installed______________________________________
Location of Project___________________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
3.Contract Amount_______________ When Completed or Percent Complete _____________
Project Description/Scope of Work: _____________________________________________
Specify green infrastructure methods installed______________________________________
Location of Project___________________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner__________________
4.Contract Amount_______________When Completed or Percent Complete _____________
Project Description/Scope of Work: ____________________________________________
Specify green infrastructure methods installed______________________________
Location of Project___________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
List all experience for the past five years in the categories for which you want to qualify. List projects that are completed or in progress, attach additional sheets if necessary.
SECTION F. - Pipe and Manhole Rehabilitation (Give pipe sizes)
(Includes point repair, pipe bursting, slip lining, etc.)
1.Project name, scope and description:___________________________________________
Contract Amount__________________________________________________________
When Completed or Percent Complete ________________________
Location of Project___________________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
2.Project name, scope and description:___________________________________________
Contract Amount___________________________________________________________
When Completed or Percent Complete ___________________________________________
Location of Project____________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
3.Project name, scope and description:____________________________________________
Contract Amount___________________________________________________________
When Completed or Percent Complete ___________________________________________
Location of Project____________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner
4.Project name, scope and description_____________________________________________
Contract Amount____________________________________________________________
When Completed or Percent Complete ___________________________________________
Location of Project____________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
List all experience for the past five years in the categories for which you want to qualify. List projects that are completed or in progress, attach additional sheets if necessary.
SECTION G. – Cured-in-Place Pipe (CIPP)
Statement of Qualifications for Cured-in-Place Pipe
Project name, scope and description_____________________________________________
Contract Amount____________________________________________________________
When Completed or Percent Complete ___________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
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)
Project name, scope and description_____________________________________________
Contract Amount____________________________________________________________
When Completed or Percent Complete ___________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
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)
List all experience for the past five years in the categories for which you want to qualify. List projects that are completed or in progress, attach additional sheets if necessary.
SECTION H. – Cured in Place Lateral Lining (CIPL)
Statement of Qualifications for cured-in-place lateral lining (includes cured-in-place lateral connection repairs).
Project name, scope and description_____________________________________________
Contract Amount____________________________________________________________
When Completed or Percent Complete ___________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
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 __________________
Project name, scope and description_____________________________________________
Contract Amount____________________________________________________________
When Completed or Percent Complete ___________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
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 __________________
List all experience for the past five years in the categories for which you want to qualify. List projects that are completed or in progress, attach additional sheets if necessary.
SECTION I. - Concrete Channels, Walls & Structures
1.Contract Amount____________________________________________________________
When Completed or Percent Complete ___________________________________________
Project Description/Scope of Work: _____________________________________________
Location of Project________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
2.Contract Amount________________
When Completed or Percent Complete ________________________
Project Description/Scope of Work: _____________________________________________
Location of Project_________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
3.Contract Amount________________
When Completed or Percent Complete ________________________
Project Description/Scope of Work: _____________________________________________
Location of Project_________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
4.Contract Amount________________
When Completed or Percent Complete ________________________
Project Description/Scope of Work: ____________________________________________
Location of Project_________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
List all experience for the past five years in the categories for which you want to qualify. List projects that are completed or in progress, attach additional sheets if necessary.
SECTION J. - Mechanical/Electrical/Plumbing
1.Contract Amount______________
When Completed or Percent Complete ________________________
Project Description/Scope of Work: _____________________________________________
Location of Project________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
2.Contract Amount________________
When Completed or Percent Complete ________________________
Project Description/Scope of Work: _____________________________________________
Location of Project_________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
3.Contract Amount________________
When Completed or Percent Complete ________________________
Project Description/Scope of Work: _____________________________________________
Location of Project_________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
4.Contract Amount________________
When Completed or Percent Complete ________________________
Project Description/Scope of Work: _____________________________________________
Location of Project_________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
List all experience for the past five years in the categories for which you want to qualify. List projects that are completed or in progress, attach additional sheets if necessary.
SECTION K. – Tunneling / Trenchless
1.Contract Amount______________
When Completed or Percent Complete ________________________
Project Description/Scope of Work: _____________________________________________
Location of Project________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
2.Contract Amount________________
When Completed or Percent Complete ________________________
Project Description/Scope of Work: ____________________________________________
Location of Project_________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
3.Contract Amount________________
When Completed or Percent Complete ________________________
Project Description/Scope of Work: _____________________________________________
Location of Project_________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
4.Contract Amount________________
When Completed or Percent Complete ________________________
Project Description/Scope of Work: _____________________________________________
Location of Project_________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
List all experience for the past five years in the categories for which you want to qualify. List projects that are completed or in progress, attach additional sheets if necessary.
SECTION L. – 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 or Percent Complete ________________________
Project Description/Scope of Work: _____________________________________________
Location of Project________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
2.Contract Amount________________
When Completed or Percent Complete ________________________
Project Description/Scope of Work: _____________________________________________
Location of Project_________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
3.Contract Amount________________
When Completed or Percent Complete ________________________
Project Description/Scope of Work: _____________________________________________
Location of Project_________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
4.Contract Amount________________
When Completed or Percent Complete ________________________
Project Description/Scope of Work: _____________________________________________
Location of Project_________________________________________________
If project is in MSD District Boundaries please indicate P# or MSD Contract No.: ________
Name, Address & Phone # of Owner_____________________________________________
EQUIPMENT
(What equipment do you own that is available for proposed work?)
QUANTITY
ITEM
DESCRIPTION, SIZE, CAPACITY, ETC
EQUIP
HOURS
CONDITION
YEARS OF SERVICE
PRESENT
LOCATION
* Condition shall be graded as follows:
New under 12 monthsOver 12 months oldRebuilt
N-10-1(Good)R-1
0-2(Average)R-2
0-3(Fair)R-3
0-4(Poor)R-4 (Poor)
SAMPLE INSURANCE REQUIREMENTS REVISED 7/19/17:
The following section supplements the provisions of Part 1, Section F, paragraph 8 of the Standard Construction Specifications (2009).
Within fifteen (15) days after written notification by the District that the bid proposal has been accepted and receipt of the contract for signature, the Contractor must provide two
(2) copies of executed Certificates of Insurance on the ISO ACORD 25 Form or current equivalent with the District, indicating that the bidder has obtained and will continue to carry
commercial general liability, comprehensive business auto liability, workers compensation/employers’ liability, excess (umbrella), professional liability and pollution liability as required.
The initial and renewal Certificates of Insurance must identify the MSD Project and Contract by name and reference number. A sample Certificate of Insurance Form in the format required
is attached to these specifications.
The Contractor shall carry and maintain adequate liability insurance as required by this Contract with a company or companies satisfactory to the District and which are:
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 AM Best Company;
or
Not licensed in the State of Missouri (Non-admitted) with a financial strength rating of “A” or better and a financial size category of Class IX or higher per AM Best Company; or
For workers compensation coverage only, organized pursuant to the Missouri Insurance Company Act (R.S.Mo §§ 287.900 to 287.920).
The insurance policy/policies 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-through” 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.
The amounts of coverage required herein shall not be construed to limit the liability of the Contractor under the indemnification provision of the contract.
The District (including its Trustees, directors, officers, agents and employees), the Consultant ___________________________, and the following Sub-consultants _____________________________,
shall be named as “Additional Insured(s)” for all required insurance coverage (with the exception of pollution liability, professional liability and workers compensation coverage) with
respect to the __________________________________ (state project). The Contractor shall require that its sub-contractors name the District and the Contractor as “Additional Insured(s)”.
The additional insured coverage must be sufficiently broad to afford the District coverage as required by the indemnification provision of the Contract and must include products and
completed operations coverage included within the commercial general liability policy.
In the event the Contractor is a joint venture, the following additional requirements shall apply:
1. If the joint venture secures separate stand-alone coverage in the name of the joint venture for one or more of the required lines of coverage, each of the requirements set forth below
shall apply to that coverage and the certificate of insurance shall so indicate. The District may request copies of the endorsements &/or policies of insurance to verify that coverage
is in the name of the joint venture.
2. If separate stand-alone coverage in the name of the joint venture is not provided for one or more of the required lines of coverage, then for each such line of required coverage,
the following requirements shall apply: (i) the coverages of each of the joint venture members must provide specific endorsements to each such line of required coverage; (ii) The joint
venture shall be endorsed to each such line of coverage; (iii) The joint venture and each member of the joint venture must be “named insureds” for each such line of coverage; and (iv)
The certificates of insurance for each such joint venture member shall be provided and shall reflect compliance with these requirements. It is anticipated that business auto and workers
compensation/employers’ liability coverage will not be secured in the name of the joint venture, and will fall in this category.
The coverage and minimum limits of liability shall be in accordance with the specifications below except as may be specifically modified elsewhere in the Contract Documents:
COMMERCIAL GENERAL LIABILITY
$1,000,000 Each Occurrence
$1,000,000 Aggregate/Per Project*
*The aggregate limits must be provided on a per project basis. Aggregate limits not provided on a per project basis must be noted on the Certificate of Insurance and the District must
approve in advance.
The Commercial General Liability (CGL) policy shall include the following:
Premises – Operations Liability
Blanket Contractual Liability
Products & Ongoing and Completed Operations Liability
Contractor’s Protective Liability (Independent Contractors)
Personal Injury Liability
Broad Form Property Damage Liability Endorsement
Coverage for explosion, collapse and underground hazards (XCU)
Blasting (provided that blasting coverage may be excluded if not to be performed in connection with the work)
If any exceptions or exclusions have been made to the standard CGL Policy, the exceptions and exclusions must be specifically listed and identified in the Description of Operations section
of the Certificate of Insurance and must be submitted to the District for approval.
If using a non-standard policy form (Form CG 00 01 04 13 or equivalent), then additional endorsements may be required.
The commercial general liability policy must provide primary and non-contributory coverage that is equivalent to the terms of ISO Form CG 20 01 04 13, Primary and Noncontributory Other
Insurance Conditions (or current equivalent).
The commercial general liability coverage including products and completed operations shall be maintained for a minimum period of five (5) years following final payment.
BUSINESS AUTOMOBILE LIABILITY
$1,000,000Combined Single Limit
Insurance shall apply to all owned, non-owned and hired vehicles. A MCS-90 endorsement shall be included on the Policy when required by Missouri law.
WORKERS COMPENSATION & EMPLOYERS’ LIABILITY INSURANCE
Workers Compensation:
Statutory Limits
Workers Compensation Insurance shall comply with all applicable State and Federal laws, including but not limited to U.S. Longshore & Harbor Workers (USL&H) Act and Jones Act.
Employers’ Liability:
$500,000Each Accident
$500,000 Disease Each Employee
$500,000 Disease Policy Limit
EXCESS (UMBRELLA) COVERAGE – Applies to CGL, Business Auto & Employers Liability
Excess coverage must be provided and with the following limits for each of the Commercial General Liability, Business Auto & Employers’ Liability coverages. These limits are in addition
to the primary limits set forth above.
Limits For Contracts $100,000 & Over:
$5,000,000 Per Occurrence
$5,000,000 Aggregate
Limits For Contracts Less Than $100,000:
$2,000,000 Per Occurrence
$2,000,000 Aggregate
POLLUTION LIABILITY
For contracts in excess of $100,000, the Contractor shall maintain in force for the full period of the Contract, pollution liability insurance coverage in the minimum amount set forth
below for losses caused by sudden and non-sudden pollution conditions that arise from the operations of the Contractor. 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, and shall cover cleanup, transportation, disposal, remediation and defense costs, including
all expenses incurred in the investigation, defense, payment or settlement of claims.
$2,000,000Per Claim or Occurrence
$2,000,000Aggregate
If claims made, the insurance coverage shall be retroactive to the earlier of the date of this Contract or the commencement of the Contractor’s work on the Project, and Contractor shall
cause the same to remain in effect for a period of at least five (5) years after final acceptance of the Project by the District or such other period as may be set forth in the Contract
or in the Project Specifications.
NOTE: For contracts less than $100,000, the District does not require the Contractor to provide pollution liability coverage for the District. The Contractor may wish to provide such
coverage for its own protection. The District is not providing such coverage to the Contractor.
PROFESSIONAL LIABILITY
For contracts in excess of $5,000,000, Contractor shall maintain, or shall cause its subcontractor(s) providing professional design or advice to maintain, in force for the duration of
this Contract errors and omissions/professional liability insurance. Coverage as required in this Article shall apply to liability for professional errors, acts or omissions arising
out of the scope of the Contractor’s services as set forth in this Contract and the Project Specifications.
$2,000,000Per Claim or Occurrence
$2,000,000Aggregate
If claims made, the insurance coverage shall be retroactive to the earlier of the date of this Contract or the commencement of the Contractor’s work on the Project, and Contractor shall
cause the same to remain in effect for a period of at least five (5) years after final acceptance of the Project by the District or such other period as may be set forth in the Contract
or in the Project Specifications.
NOTE: If Contractor provides combined Pollution Liability and Professional Liability coverage, separate limits in the amounts required must be provided. If a policy aggregate applies,
the certificate of insurance must so indicate and the amount must be approved by the District.
DEDUCTIBLE/SELF-INSURED RETENTION:
For any coverage, a deductible or retention that exceeds $100,000 shall be noted and approved by the District’s Risk Management Group. The District will reserve the right to review
the funding for a deductible or retention program. Satisfaction of any such deductible or retention shall be the sole responsibility of the Contractor. If self-insured, the District
reserves the right to request acceptable proof of financial responsibility before approval.
CANCELLATION:
Should any of the required insurance coverage be cancelled prior to the expiration date, the Contractor must provide at least sixty (60) days written notice to the District prior to
the cancellation. For policy cancellation for non-payment of premium by the Contractor, the Contractor must notify the District at least ten (10) calendar days prior to the cancellation.
Cancellation provisions within any coverage shall be in accordance with Missouri Cancellation and Non-Renewal provisions. It is the duty of the Contractor to notify the District of any
cancellation or non-renewal and provide the District 60 days’ notice.
REPLACEMENT POLICY:
Should any of the required insurance coverage be cancelled, terminated or materially altered, the Contractor will send written notice to MSD at least sixty (60) days prior to the effective
date of said cancellation, termination or alteration. Upon receipt of any notice of insurance cancellation, termination or alteration, the Contractor shall within thirty (30) days
procure other policies of insurance identical in all respects to the policy or policies about to be canceled, terminated or altered and shall provide the District with evidence of coverage
before the cancellation or termination date; and if the Contractor fails to provide, procure and deliver acceptable policies of insurance and satisfactory certificates or other evidence
thereof, the District may obtain such insurance at the cost and expense of the Contractor without notice to the Contractor, and elect to pursue any other remedy permitted by law or the
contract terms, including but not limited to termination of the Contract.
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
AFFIDAVIT FOR CORPORATION
STATE OF _____________)
) ss
COUNTY/CITY OF ___________)
AFFIDAVIT
I, ____________________, depose and state as follows:
I am the _________________(title) of _____________________________________;
I am authorized to sign this Affidavit on behalf of the corporation;
The foregoing information and responses to interrogatories set forth herein are true and correct to the best of my knowledge, information and belief; and
Any depository, vendor, agency or entity herein named is authorized to supply The Metropolitan St. Louis Sewer District with any information appropriate to verify the accuracy of any
statement herein.
In witness hereof I have hereunto subscribed my name and affixed the official seal of the corporation this day of ____, 20.
Affiant
(Seal)
Subscribed and sworn to before me, a Notary Public, this day of
, 20___.
Notary Public
My commission expires:
AFFIDAVIT FOR PARTNERSHIP
STATE OF _____________)
) ss
COUNTY/CITY OF ___________)
AFFIDAVIT
I, ____________________, depose and state as follows:
I am a partner in the partnership known as ____________________________________________________________;
I am authorized to sign this Affidavit on behalf of the partnership;
The foregoing information and responses to interrogatories set forth herein are true and correct to the best of my knowledge, information and belief; and
Any depository, vendor, agency or entity herein named is authorized to supply The Metropolitan St. Louis Sewer District with any information appropriate to verify the accuracy of any
statement herein.
In witness hereof I have hereunto subscribed my name this __ day of
________________, 20.
Affiant
(Seal)
Subscribed and sworn to before me, a Notary Public, this day of
, 20___.
Notary Public
My commission expires:
AFFIDAVIT FOR JOINT VENTURE
STATE OF _____________)
) ss
COUNTY/CITY OF ___________)
AFFIDAVIT
I, ____________________, depose and state as follows:
I am a joint venture partner &/or am authorized to sign this Affidavit on behalf of the Joint Venture between _______________________ and _________________________;
The foregoing information and responses to interrogatories set forth herein are true and correct to the best of my knowledge, information and belief; and
Any depository, vendor, agency or entity herein named is authorized to supply The Metropolitan St. Louis Sewer District with any information appropriate to verify the accuracy of any
statement herein.
In witness hereof I have hereunto subscribed my name this __ day of
________________, 20.
Affiant
(Seal)
Subscribed and sworn to before me, a Notary Public, this day of
, 20___.
Notary Public
My commission expires:
AFFIDAVIT FOR INDIVIDUAL
STATE OF _____________)
) ss
COUNTY/CITY OF ___________)
AFFIDAVIT
I, _____________________________________, depose and state under oath that the foregoing information and responses to interrogatories set forth herein are true and correct to the best
of my knowledge, information and belief. Any depository, vendor, agency or entity herein named is authorized to supply The Metropolitan St. Louis Sewer District with any information
appropriate to verify the accuracy of any statement herein.
In witness hereof I have hereunto subscribed my name and affixed my official seal this day of ____, 20.
Affiant
(Seal)
Subscribed and sworn to before me, a Notary Public, this day of
, 20__.
Notary Public
My commission expires:
AFFIDAVIT FOR LIMITED LIABILTY COMPANY
STATE OF _____________)
) ss
COUNTY/CITY OF ___________)
AFFIDAVIT
I, ____________________, depose and state as follows:
I am the _________________(title) of _____________________________________, a limited liability company;
I am authorized to sign this Affidavit on behalf of the limited liability company;
The foregoing information and responses to interrogatories set forth herein are true and correct to the best of my knowledge, information and belief; and
Any depository, vendor, agency or entity herein named is authorized to supply The Metropolitan St. Louis Sewer District with any information appropriate to verify the accuracy of any
statement herein.
In witness hereof I have hereunto subscribed my name on this day of ____, 20.
Affiant
(Seal)
Subscribed and sworn to before me, a Notary Public, this day of
, 20___.
Notary Public
My commission expires:
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