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Consultant Prequalification Questionnaire 2019October 23, 2018 To Whom It May Concern: MSD is conducting its annual Engineering Consultant Qualifications. In an effort to streamline the process you now have three options to consider: 1. RENEWAL ONLY — If you have no major changes to your company or staffing, and no additional categories are requested, you can do the abbreviated renewal process. a. To renew your company's existing prequalification (existing prequalification available upon request) for another year you must complete the following documents and submit them as one (1) PDF to the email address listed below: i. Complete the first page ii. Signed affidavit indicating no substantial organizational changes in last year iii. Current copy of Professional License (Engineering, Land Surveying and/or Architectural) for firm issued by the State of Missouri iv. Current copy of Firm's MBE/WBE certification (if applicable) v. Current copy of Firm's Professional Liability Insurance coverage vi. Vendor's Conflict of Interest Questionnaire, along with Attachment A 2. NOTIFICATION ONLY — If your firm only wants to receive notifications related to upcoming opportunities, just complete the first page and return. a. Please complete the first page of the attached APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES. Check the box for Notifications Only and submit a PDF of the completed page to the email address listed below. 3. FULL QUALIFICATION — For all new qualifications or if you have had substantial changes at your firm, including major staffing changes, you will need to submit the entire Engineering Consultant Qualification package to the email address listed below. a. Please follow the revised checklist on Page 2, which lists attachments required for pre - qualification. If any of the required attachments are not included with your pre -qualification form, your firm will be rejected. • ATTACHMENT A FOR THE CONFLICT OF INTEREST POLICY HAS BEEN REVISED. • WE ARE REQUIRING THAT YOU PLEASE SUBMIT THE ATTACHED 2019 QUESTIONNAIRE AS ONE (1) PDF TO THE FOLLOWING EMAIL: msdengpc stlmsd.com Completed forms must be submitted to the above email address by Monday, January 7, 2019. Firms submitting forms after this date may be excluded from consideration for future capital improvement projects. Also, please do not change our format or page numbers since we reference certain pages for pertinent information. If you should have any difficulty in opening this electronic file or have any questions regarding the format or the submittal process of this document, please contact Sharon Holt at (314) 768-6285. Sincerely, Richard L. Unverferth, P.E. Director of Engineering Attachment APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES THE METROPOLITAN ST. LOUIS SEWER DISTRICT 2350 MARKET STREET ST. LOUIS, MO 63103 (USED IN PREQUALIFYING CONSULTANTS ON ARCHITECTURAL, ENGINEERING, AND SURVEYING SERVICES) January 1, 2019 through December 31, 2019 Submitted By (Company as shown on License) Address (St. Louis Office) City, State, Zip Code Telephone and Fax E-Mail Address Name of Contact for Firm Date 0 Notifications Only APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES APPLICATION CHECKLIST FOR REQUIRED ATTACHMENTS (Required attachments are not included in the application packet.) Revised October 2018 * Items required for RENEWAL ONLY applications 1 Current copy of Professional Engineering License for firm issued by the State of Missouri (if applicable — as noted on page 5)* 2 Current copy of Professional Land Surveying License for firm issued by the State of Missouri (if applicable — as noted on page 5)* 3 Current copy of Architectural License for firm issued by the State of Missouri (if applicable — as noted on page 5)* 4 Current copy of Firm's MBE/WBE certification (if applicable — as noted on page 5)* 5 Firm's City, State, and Country of Corporate Headquarters (page 5) 6 Current copy of Firm's Professional Liability Insurance coverage (pages 8 & 27)* 7 Signature for Qualifications and Experience (page 12) 8 Agreement to Notify District of Organizational Changes (page 15) 9 Vendor's Conflict of Interest Questionnaire, along with Attachment A (page 22)* 10 Affidavit (page 26a through 26e as appropriate) 11 Affidavit (page 26f)* If you should have any difficulty in opening this electronic file or have any questions regarding the format or the submittal process of this document, please contact Sharon Holt. Sharon L Holt Senior Office Associate Director of Engineering's Office Metropolitan St. Louis Sewer District 2350 Market Street St. Louis, MO 63103-2555 314-768-6285 slholt(stlmsd.com 2 APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES General Information on Selection Process The Metropolitan St. Louis Sewer District utilizes a Qualifications Based Selection (QBS) process to select qualified firms to provide the necessary professional services to assists the District in the implementation of its Capital Improvement and Replacement Program (CIRP). In an effort to expedite the selection process, the District annually* pre -qualifies design consultants in specific areas of expertise, based on the general information provided in this document. This list of pre -qualified firms is used to develop a consultant "short-list" for projects that typically have a total design budget of less than $500,000. The short-list of consultants is asked to send a response to a Request for Proposal (RFP) for specific projects. For more complex projects (typically having a design budget of $500,000 or more) a Request for Qualifications for the specific project(s) is sent to all pre -qualified firms. A short-list is then developed and RFPs sent to those firms. More details about the District's QBS process can be found on the District's website www.stlmsd.com Consultants must have a fully functioning office within the District's boundaries, as defined in Part II of the application, to be considered for pre -qualification. *The District will accept and review pre -qualification information throughout the year should there be a significant change in a firm's qualification information or a firm recently opened an office within the District's boundaries. Contractual Approach The District typically utilizes two approaches in engaging professional services. In the first, General Services Agreements (GSA) are utilized to provide staff extension or specialized expertise that the District does not have for multiple small projects that typically have a construction budget of $300,000 or less. Firms wishing to be considered for this type of contractual work must have sufficient local staffing to provide the flexibility and quick response that is sometimes needed for these types of projects. GSA contracts typically range in value from $50,000 to $150,000. The second approach is to engage professional services for individual capital projects that generally have a design schedule of six (6) months to a year. For these types of services the qualifying firm may not be required to have the same depth of staffing as would be required for a GSA contract, depending on the project scope and level of difficulty. Applicants interested in pre -qualifying for one or both types of contractual services must do so by completing the appropriate sections of Part III of this application. Other Services On occasion, the District may seek services in areas not included in this pre -qualification package. In these instances, all pre -qualified consultants will be offered the opportunity to respond to a Request for Qualifications for these services. 3 APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES INSTRUCTION TO APPLICANTS All firms wishing to be pre -qualified must complete all parts of this application. Failure to adequately complete any part of this application could result in the rejection of the application in its entirety. Part I DETAILED INFORMATION ABOUT THE FIRM (Page 5) Part II ST. LOUIS OFFICE INFORMATION (Page 9) Part III QUALIFICATIONS AND EXPERIENCE (Page 12) Part IV AGREEMENT TO NOTIFY DISTRICT OF ORGANIZATIONAL CHANGES (Page Part V Part VI 15) CONFLICT OF INTEREST POLICY AND VENDOR'S CONFLICT OF INTEREST QUESTIONNIARE (Page 16) AFFIDAVITS (Page 26) ATTACHMENT B — MSD's MINIMUM INSURANCE REQUIREMENTS (Page 27) The applicant must also attach a copy of the following documents: • License issued by the State of Missouri authorizing the rendering of architectural, professional engineering, or land surveying services (as appropriate) • MBE/WBE Certificate (if applicable) • Executed Agreement to Notify District of Organizational Changes (Part IV, Page 15) • Executed Vendor's Conflict of Interest Questionnaire (Part V, Page 22) • Executed Affidavit in accordance with Company's status (See Pages 26a through 26e) • Executed Affidavit for Renewal Only (if applicable) • Current Insurance Certificate that demonstrates that the firm meets the minimum insurance requirements of the District (see Attachment B, Page 27) 4 APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES PART I — DETAILED INFORMATION ABOUT THE FIRM Name of Company Principal Address City & State Zip City, State & Country of Corporate Headquarters Type of Organization (check applicable category): A Corporation A General Partnership A Limited Liability Partnership A Limited Liability Company Sole Proprietorship Joint Venture NOTE: Attach a copy of the current License issued by the State of Missouri authorizing applicant to perform architectural, professional engineering, or land surveying services in the State of Missouri. Is your firm certified as a Minority Business Enterprise? Yes No Is your firm certified as a Women's Business Enterprise? Yes No NOTE: If yes to either of the above, attach a copy of your current certification. Visit our website for the list of acceptable agencies: www.stlmsd.com/msd-work/supplier-diversity Incorporated or organized: Date State (If a corporation, provide name and address of registered agent) List names of all partners or officers. (Note: If limited partnership, explain and please list full 100% ownership.) Name and Title Address, City, and State Fractional interest in firm or number of shares owned 5 APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES PART I — DETAILED INFORMATION ABOUT THE FIRM (cont.) 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 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 (Use additional sheets as necessary.) 6 APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES PART I — DETAILED INFORMATION ABOUT THE FIRM (cont.) List offices (by City): Type of work performed: (Specify if different in each office) Work usually sub -contracted: Location Number of Personnel 7 APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES PART I — DETAILED INFORMATION ABOUT THE FIRM (cont.) Identify any pending litigation involving applicant's work wherein applicant is a party, other than plaintiff. Insurance: List full name of each insurance company, type, and amount of coverage. (See Attachment B for District's minimum requirements.) Name Type of Coverage Amount List full name of Professional Liability Insurance Company and amount of coverage. (See Attachment B for District's minimum requirements.) Name Amount Note: Attach your firm's current Certificate of Insurance. Estimated Annual Capacity (Billings for the last three (3) years): How many years have you operated under the above name? 8 APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES PART II — ST. LOUIS OFFICE INFORMATION (The District requires that a qualifying firm maintain a full-time (fully staffed) office within the District boundaries that operates as a self-sufficient office.) A. Address of Office Located within the District's Boundary (St. Louis Office): B. Number of Years at this Address: C. Number of Years at any other address within the District's Boundary: D. Personal History Statement of all Principals located in the St. Louis office: (Furnish complete relevant data.) Name: Education [degree(s), school(s) & year(s)]: Registrations (state, license expiration date, registration number): Experience: St. Louis Office Prior to this office As a Principal As a Key Person (Project manager, office manager, etc.) Number of Years Name: Education [degree(s), school(s) & year(s)]: Registrations (state, license expiration date, registration number): 9 APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES Experience: St. Louis Office Prior to this office As a Principal As a Key Person (Project manager, office manager, etc.) Number of Years Name: Education [degree(s), school(s) & year(s)]: Registrations (state, license expiration date, registration number): Experience: St. Louis Office Prior to this office As a Principal As a Key Person (Project manager, office manager, etc.) Number of Years Name: Education [degree(s), school(s) & year(s)]: Registrations (state, license expiration date, registration number): Experience: St. Louis Office Prior to this office As a Principal As a Key Person (Project manager, office manager, etc.) (Use additional sheets as necessary.) Number of Years 10 APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES E. Personal History Statement of the St. Louis Office Manager: (Furnish complete relevant data. In the event spaces provided are not sufficient for entries in this entire questionnaire, add additional sheets with appropriate reference.) Name: Education [degree(s), school(s) & year(s)]: Registrations (state, license expiration date, registration number): Experience: St. Louis Office Prior to this office As a Principal As a Key Person (Project manager, office manager, etc.) F. St. Louis Office Staffing Information (Full-time employees only): STAFF Professional Engineers (MO P.E.) Engineers not licensed in Missouri (including FE) Professional Land Surveyors Licensed in Missouri Land Surveyors not licensed in Missouri (including LSIT) Professional Architect (MO A.I.A.) CADD Technicians Microstation Technicians Clerical Others, including non-fulltime (please specify below) Others: Number of Years Number 11 APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES PART III — QUALIFICATIONS AND EXPERIENCE The undersigned hereby applies to the Executive Director of the Metropolitan St. Louis Sewer District for a Certificate of Qualification to propose work in the following areas of expertise: (Check each type of work for which qualification is requested and complete the related Part III Section for each category.) GENERAL SERVICES AGREEMENT (GSA) CONTRACTS IN THE AREAS OF: ❑ Construction Management (Requires P.E.) — This work typically consists of the inspection of sewer construction and private lateral connections, material testing, pipe and manhole testing and other miscellaneous construction management services. o Please indicted if your company has staff members experienced in Sewer Inspection that is currently 40 Hour Hazwoper Certified? Yes No ❑ Geotechnical Services (Requires P.E.) — This work typically consists of geotechnical investigation for small storm or sanitary sewer projects and may include performing borings or test holes, evaluating and recommending shoring, foundation, excavation and pipe support methods, and evaluating and recommending solutions to slope failures, foundation, and pipe bedding problems. ❑ Sewer and Channel Design (Requires P.E.) — This work typically consists of the preparation of complete construction plans and specifications for small projects which could include sanitary, storm, and combined sewers as well as stormwater channels. ❑ Sewer and Process Design (Requires P.E.) — This work typically consists of the preparation of complete construction plans and specifications for small projects which could include sanitary, storm, and combined sewers as well as wastewater treatment plant and pump station improvements. ❑ Surveying (Requires P.L.S.) — This work typically consists of providing a variety of surveying services such as GPS surveys, land surveys, property surveys and strip map preparation, easement plat preparation, and other miscellaneous survey -related work. PROJECT -SPECIFIC CONTRACTS IN THE AREAS OF: ❑ Sewers (Requires P.E.) — This work typically consists of preparation of plans and specifications for the construction of sanitary and storm sewer relief projects. ❑ Large Facilities (Requires P.E.) — This work typically consists of preparation of plans and specifications for the construction of new treatment plants and major pump stations or improvements to existing treatment plants and major pump stations. ❑ Small Pump Stations (Requires P.E.) — This work typically consists of preparation of plans and specifications for the construction of new pump stations, or modifications of existing pump stations whose design criteria falls under the District's Pump Station Design Requirements. ❑ Natural Channel Restoration (Requires P.E.) — This work typically consists of the preparation of complete construction plans and specifications for projects with an emphasis on the restoration of natural stormwater channels, often with bio-stabilization techniques. ❑ Building (Architectural, Electrical, Mechanical and Structural) (Requires P.E. and/or A.I.A.) — This work typically consists of preparation of plans and specifications for the construction of interior improvements or building expansion of existing administration buildings, or construction of new facilities. Signature Name & Title (Please Print) 12 APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES PART III — QUALIFICATIONS AND EXPERIENCE (cont.) CATEGORY BEING APPLIED FOR: ❑ Construction Management (Requires P.E.) ❑ Geotechnical Services (Requires P.E.) ❑ Sewer and Channel Design (Requires P.E.) ❑ Sewer and Process Design (Requires P.E.) ❑ Surveying (Requires P.L.S.) ❑ Sewers (Requires P.E.) ❑ Large Facilities (Requires P.E.) ❑ Small Pump Stations (Requires P.E.) ❑ Natural Channel Restoration (Requires P.E.) 0 Building (Architectural, Electrical, Mechanical and Structural) (Requires P.E. and/or A.I.A.) Demonstrated Project Experience/Key Personnel (Separate sheets must be submitted for each category being applied for.): (Provide information about the five (5) most recently completed or currently active projects completed by the firm within the last three years that demonstrate the firm's experience in this category. If firm acted as a subconsultant or was part of a joint venture, please describe firm's role in project in the Subconsultant or Joint Venture section. Projects do not have to have been in the St. Louis area.) Project Name: Location: Owner: Description of Work: Year Work Completed: Construction Cost: Design Fee: Key Personnel: Role as Subconsultant or in Joint -Venture: Project Name: Location: Owner: Description of Work: Year Work Completed: Construction Cost: Design Fee: Key Personnel: Role as Subconsultant or in Joint -Venture: 13 APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES Project Name: Location: Owner: Description of Work: Year Work Completed: Construction Cost: Design Fee: Key Personnel: Role as Subconsultant or in Joint -Venture: Project Name: Location: Owner: Description of Work: Year Work Completed: Construction Cost: Design Fee: Key Personnel: Role as Subconsultant or in Joint -Venture: Project Name: Location: Owner: Description of Work: Year Work Completed: Construction Cost: Design Fee: Key Personnel: Role as Subconsultant or in Joint -Venture: 14 APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES PART IV — AGREEMENT TO NOTIFY DISTRICT OF ORGANIZATIONAL GHANGES UWe will from time to time, when significant changes occur in our organization or in the information furnished above, forward such revised data to be incorporated in this statement to keep the record current. NAME OF FIRM OR INDIVIDUAL: Signed by Authorized Member of Firm: Title Please return this questionnaire and all supporting documentation to: WE ARE REQUIRING THAT YOU PLEASE SUBMIT THE 2019 QUESTIONNAIRE AS A PDF TO THE FOLLOWING EMAIL: msdengpq( stlmsd.com. If you have any questions please contact: Sharon L Holt Director of Engineering's Office 2350 Market Street St. Louis, MO 63103 314-768-6285 15 NUMBER: H-3 ISSUED: 09/15/2017 GENERAL MANAGEMENT POLICY/PROCEDURE APPROVED BY: EXECUTIVE DIRECTOR TOPIC: CONFLICT OF INTEREST POLICY Supersedes Policy Issued: 09/15/2015 PURPOSE This Policy is meant to promote an ethical business environment at The Metropolitan St. Louis Sewer District, and to ensure compliance with all state ethics requirements. This Policy supersedes and replaces any prior policies, rules, practices, standards or guidelines to the contrary, whether written or oral. Other District policies, procedures and guidelines shall continue to apply to the extent not inconsistent with this Policy. POLICY To promote an ethical environment of unquestionable integrity and to comply with state requirements, the District requires all employees, as well as Trustees, to refrain from conflicts of interest involving any and all business transactions involving the District. Furthermore, the District expects that all employees and Trustees will use their best judgment in all business dealings with customers, suppliers, contractors, governmental and regulatory agencies, the media and vendors, that they will refrain from unethical actions, and that they will disclose all relevant outside employment and business transactions. This Policy details all such requirements. A "conflict of interest" occurs when your private interest interferes or appears to interfere in any way with the interests of the District. You are expected to avoid all situations that might lead to a real or apparent material conflict between your self-interest and your duties and responsibilities as an employee, officer or Trustee of the District. Any position or interest, financial or otherwise, which could materially conflict with your performance as an employee, officer or Trustee of the District, or which affects or could reasonably be expected to affect your independence or judgment concerning transactions between the District, its customers or suppliers or otherwise reflects negatively on the District would be considered a conflict of interest and should be avoided. A conflict of interest should be properly disclosed by the affected Trustee or District employee at the earliest opportunity. PROCEDURE 1. Conflict of Interest 16 (a) Members of the Board of Trustees and all District employees must avoid all conflicts of interest and the appearance of impropriety when representing the District in business dealings or making any recommendations which could affect the District. In addition, each employee must disclose any actual or apparent conflict of interest to his or her supervisor and/or the Director of his or her department. Members of the Board of Trustees must disclose any actual or apparent conflict of interest to the full Board of Trustees. (b) It is not practical or possible to specify all activities which may create a conflict of interest; however, situations that are related to the procurement process that should be avoided by Trustees and District employees include: (1) Owning any interest (other than nominal amounts of stock in publicly traded companies) in any supplier, service provider, consultant, or lessor; (2) Consulting with or being an employee of any customer, lessor, contractor, service provider, consultant, or supplier (without prior written approval of his/her departmental director); (3) Purchasing goods and services from, or selling them to, the District or having a business associate or close relative do the same (unless done through an established program of disposal of surplus District property offered to the general public); (4) Participation in outside activities which are so substantial that they interfere with an employee's ability to devote appropriate time and attention to his or her job responsibilities with the District; (5) Serving on the Board of Directors of any customer, lessor, contractor, service provider, consultant, supplier or other entity doing or seeking to business with the District. However, if avoidance is impractical, full disclosure must be made and the individual must abstain from participating in any votes concerning the entity in question; and (c) In addition to all other requirements of this section, and in accordance with state statutes, Trustees and District employees may not: (1) Have any contracts or arrangements with the District to perform any services outside of the scope of their regular employment; (2) Sell, rent, or lease any property to the District; and (3) Work for any person or entity in relation to any case, proceeding, application or matter that they worked on during their employment with the District except to the extent expressly allowed by law. (d) For each of the individuals named in (c) above, written disclosure must be made of any outside employment, other than with the District. 17 (e) If a Trustee has a significant business relationship as an individual or through his or her employer with a vendor doing or being considered to do business with the District, the Trustee must inform the full Board of the business relationship and recluse himself or herself from voting on said matter. If the existence of a conflict of interest is undetermined, the subsequent inquiry may include disclosure of the nature of the business relationship, the amount of annual charges resulting from the relationship, and whether any of the charges relate, directly or indirectly to the business of the District. Intentionally providing materially false or misleading information, or omitting material information, shall constitute malfeasance in office for any Trustee, subjecting the Trustee to removal as provided in the Charter of the District. Furthermore, by definition, actions taken by a Trustee on behalf of the District based solely on the existence of a personal relationship between the Trustee and a vendor constitutes a conflict of interest. (f) If an employee has a significant business relationship as an individual or through an employer other than the District with a vendor doing or being considered to do business with the District the employee must inform his or her supervisor and/or the Director of his or her department of the business relationship. If the existence of a conflict of interest is undetermined, the subsequent inquiry may include disclosure of the nature of the business relationship, the amount of annual charges resulting from the relationship, and whether any of the charges relate directly or indirectly to the business of the District. Intentionally providing materially false or misleading information, or omitting material information, shall be cause for termination of employment with the District. Furthermore, by definition, actions taken by an employee on behalf of the District based solely on the existence of a personal relationship between the employee and a vendor constitutes a conflict of interest. (g) Additionally, the following acts are expressly prohibited for all Trustees and employees of the District: (1) Acting or refusing to act in any capacity in which he or she is empowered to act by reason of payment, offer to pay, or promise to pay, or receipt of gifts or anything of value. (2) Using or disclosing confidential information gained in the course of employment or term as a Trustee with the intent to obtain financial gain for him or herself, his or her spouse or children, or any business with which he or she is associated, or for the purpose of extorting anything of value from another. (3) Acting in any matter which specifically gives special monetary benefit to himself or herself, his or her spouse or children, any close family members or any business associate. 2. Interpretation and Administration This Policy shall be administered and interpreted as follows: (a) In the case of employees who are not managers, by the human resources department in consultation with the General Counsel. (b) In the case of employees who are managers, by the Executive Director in consultation with the General Counsel. 18 (c) In the case of Trustees, by the disinterested Trustees in consultation with the General Counsel. 3. Business Relationships (a) The District considers its reputation for fairness and integrity one of its most valuable assets. Employees are expected to use good judgment in all dealings with individuals, service providers, consultants, suppliers, or firms which seek to become a supplier of goods or services to the District and all customers of our services. To that end, Trustees or District employees must conduct their business affairs so that the District's integrity is unquestionable if the full details of those dealings were to become public. (b) To illustrate the high ethical standards expected of every Trustee and every employee of the District, the following conduct is expressly prohibited: (1) Receiving or soliciting money, loans or other favors which may influence business decisions or compromise independent judgment; (2) Receiving or soliciting gifts of money in any amount or any other gifts of more than a nominal value; a gift of nominal value is one that a company or individual routinely provides as part of their customary and normal business practices (all gifts must be reported in accordance with state ethics laws, if applicable); (3) Receiving or soliciting any trip without the employee's supervisor's prior written approval; (4) Receiving or soliciting kickbacks for obtaining business from the District; (5) Degrading the District's reputation through any other activities which are of questionable integrity. (c) These guidelines are not intended to prevent the District from taking normal prompt payment discounts. They also do not prohibit receiving inexpensive gifts or services which are unsolicited and acceptable under normal and customary social circumstances, so long as the gratuity is not offered with a corrupt intent and does not influence or compromise the conduct of the recipient. In addition, the guidelines do not prohibit normal business entertainment expenses that are neither lavish nor solicited. (d) If any Trustee or employee of the District is requested to make or accept a gift or payment that is prohibited or may even appear to be prohibited under this Policy, the request and all surrounding circumstances should immediately be disclosed to the District's General Counsel who will advise the appropriate course of action. 4. Disciplinary Action Violations of this Policy involving employees will be handled on a case -by -case basis and disciplinary action could cover the full range of actions permitted under the District's Civil Service Rules. Violations of the Policy involving Trustees will be reviewed and handled by disinterested Trustees in consultation with the General Counsel. 19 5. Compliance with Laws, Rules and Regulations This Policy is based on the District's policy that all employees, officers and Trustees comply with the law. While the law prescribes a minimum standard of conduct, this Policy requires conduct that often exceeds the legal standard. All employees, officers and Trustees are required to respond honestly and candidly when dealing with the District's independent and internal auditors, regulators and attorneys. 6. Reporting of Illegal and Unethical Behavior Fraud is an element of business that can significantly affect the reputation and success of the District. The District requires its employees, officers and Trustees to talk to supervisors, managers or other appropriate personnel to report and discuss any known or suspected criminal activity involving the District or its employees. If, during the course of your affiliation with the District, you become aware of any suspicious activity or behavior including concerns regarding questionable accounting or auditing matters, you must report violations of laws, rules, regulations or this Policy to your supervisor, the Director of Human Resources or the General Counsel. Reporting the activity will not subject you to discipline absent a knowingly false report. 7. Misappropriation Anyone who embezzles, steals or willfully misappropriates any monies, funds or anything of value from the District may be subject to fine, imprisonment, restitution payment and other such actions conferred by law or District policy, in addition to disciplinary action. 8. Investigation You must cooperate fully with any investigation, internal audit, external audit or regulatory examination. If an employee becomes aware that he or she is or has been the subject to any external investigation, the employee must immediately inform his or her supervisor and/or Director of the department, unless otherwise prohibited by law, regulation or the investigating authority. Trustees shall inform the disinterested Trustees and the General Counsel. 9. Financial Disclosure Statement In accordance with Missouri State Statutes, the following positions are required to submit annually, a Financial Disclosure Statement to the State: (a) Members of the Board of Trustees (b) Executive Director (c) General Counsel (d) All Director -level positions (e) Purchasing Manager 20 (0 Other personnel as identified by the Board of Trustees Such Financial Disclosure Statements shall be filed within 30 days of appointment for new appointees, and no later than May 1 of each calendar year for all others. 10. Employees and Immediate Family Members, Selling to the District. (a) Employees and Immediate Family Members of the District: Employees of the District, and members of their immediate family, will not be permitted to sell goods and/or services to the District. 21 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: 22 ATTACHMENT A 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 U . dated Janu. 2, 2018 MSD BOARD OF TRUSTEES & DIRECTORS Name of Firm, Organization or Company Affiliation Rev. Ronald Bobo, Sr. Trustee Freddie Dunlap Trustee James Faul Trustee Marion M. Gee Director Brian Hoelscher Executive Director Annette K. Mandel Trustee Barbara Mohn Director Susan M. Myers Director V NAACP Sharing Hope International Ministries St. Louis & Vicinity Baptist Ministers Union St. Louis Clergy Coalition West Side Missionary Baptist Church City of St. Louis Employee Retirement System St. Louis Soldiers Memorial Military Museum Hartnett Gladney Hetterman, LLC Illinois Bar 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 American Water Works Association (AWWA) Church on The Rock Government Finance Officers Association (GFOA) Missouri Government Finance Officers Association 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 Central West End Planning & Development Committee Missouri Athletic Club Missouri Bar Association Missouri Botanical Gardens Missouri History Museum St. Louis Zoo USO Missouri Water Wastewater CIO Forum Women Executives in IT (WEIT) Association of Corporate Counsel Association of Missouri Cleanwater Agencies (AMCA) Bar Association of Metropolitan St. Louis Missouri Bar Association Missouri Chamber of Commerce National Association of Cleanwater Agencies (NACWA) Member Member Member Member Member Member Trustee Commissioner Partner Member Member Member Member Member Member Member Member Member Member Executive Board Member Member Member Member Ambassador/Connector Executive Council Member Member Member Member Member Member Member Volunteer Member Member Member Member Member Member Member Member Trustee/Director Updated January 2, 2018 MSD BOARD OF TRUSTEES & DIRECTORS Name of Firm, Organization or Company Affiliation Betsy Schubert Manager James I. Singer Trustee Timothy R. Snoke Director Jonathon Sprague Director Institute for Supply Management AFL-CIO Lawyers Coordinating Committee American Bar Association American College of Employee Benefit Counsel Bar Association of Metropolitan St. Louis Electricians Historical Society Illinois Bar Missouri Bar Missouri Botanical Gardens Missouri Historical Society Schuchat, Cook and Werner Shaare Emeth Congregation St. Louis University Law School St. Louis Zoo Member Member Member Member Member Board member Member Member Member Member Partner Member Adjunct Faculty Member Board Member, Contractor Loan Fund Executive Committee 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 American Water Works Association (AWWA) Member Engineers Club of St. Louis Member Missouri Water Environment Member National Association of Clean Water Agencies (NACWA) Member Water Environment Federation Member Vicki Taylor -Edwards AAIM Management Association Member Director Alpha Kappa Alpha Sorority Member Certified Employee Benefits Association Member Compensation Benefits Network Member Human Resources Management Association Member International Public Management Association Member Shalom City of Peace Member Rich L. Unverferth Director Engineers Club of St. Louis Member Knights of Columbus - Council 2119 Webster Groves Member National Association of Clean Water Agencies (NACWA) Member St. Michael the Archangel Catholic Parish Member Executive Board Michael E. Yates North County Labor Legislative Club Member Trustee St. Louis Labor Council Delegate NOTE: Please execute the appropriate Affidavit in accordance with your company's status. 25 AFFIDAVIT FOR CORPORATION State of ) ) ss. County of ) , being duly sworn, deposes and says that he is of the applicant and that the information furnished in this questionnaire is true, correct, and complete. Title Title Sworn to before me, this Notary Public (seal) day of , 20 26a AFFIDAVIT FOR LIMITED LIABILITY COMPANY (LLC) State of ) ) ss. County of ) , being duly sworn, deposes and says that _ he is of the applicant and that the information furnished in this questionnaire is true, correct, and complete. Title Title Sworn to before me, this day of , 20 Notary Public (seal) 26b AFFIDAVIT FOR LIMITED LIABILITY PARTNERSHIP (LLP) State of ) ) ss. County of ) , being duly sworn, deposes and says that he is of the applicant and that the information furnished in this questionnaire is true, correct, and complete. Title Title Sworn to before me, this Notary Public (seal) day of , 20 26c State of AFFIDAVIT FOR GENERAL PARTNERSHIP County of ) ss. , being duly sworn, deposes and says that he is of the applicant and that the information furnished in this questionnaire is true, correct, and complete. Title Title Sworn to before me, this Notary Public (seal) day of , 20 26d AFFIDAVIT FOR SOLE PROPRIETORSHIP State of ) ) ss. County of ) , being duly sworn, deposes and says that the information furnished in this questionnaire is true, correct, and complete. Title Title Sworn to before me, this Notary Public (seal) day of , 20 AFFIDAVIT FOR RENEWAL ONLY State of ) ) ss. County of ) , being duly sworn, deposes and says that: • The information furnished in this questionnaire is true, correct, and complete. • That the company asking for the RENEWAL ONLY qualification has not had substantial changes to the company of loss of KEY PERSONNEL since the last submittal ofthe APPLICATION FOR CERTIFICATE OF QUALIFICATIONS TO PROPOSE FOR PROFESSIONAL SERVICES to MSD. Title Title Sworn to before me, this Notary Public (seal) day of , 20 26f ATTACHEMENT B (Article 8 of MSD Standard Contract) 8.1 Within fifteen (15) days after written notification by the District that the fee proposal has been accepted and receipt of the Contract for signature, the Consultant must provide two (2) copies of executed Certificate(s) of Insurance on the ISO ACORD 25 Form or current equivalent with the District, indicating that the Consultant has obtained and will continue to carry commercial general liability, comprehensive automobile 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 has been provided to Consultant and is to be followed. 8.2 Consultant shall carry and maintain adequate liability insurance as required by this Contract with a company or companies satisfactory to the District and which are (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 AM Best Company; or (2) 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 (3) with regard to worker's compensation coverage only, organized pursuant to the Missouri Insurance Company Act (R.S. Mo. §§ 287.900 to 287.920). An insurance policy will be acceptable regardless of the above requirements if the insurance company furnishes a 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 in the preceding sentence. 8.3 The amounts of coverage required herein shall not be construed to limit the liability of the Consultant under the Indemnification provision of the Contract. 8.4 The District (including its trustees, agents, directors, officers, attorneys and employees and if applicable to the particular project and required by the project specifications, its consultants and sub -consultants), shall be named as "Additional Insured(s)" for all required insurance coverage with respect to the work covered by the Contract (with the exception of pollution liability, professional liability and workers compensation coverage). The Consultant shall require that its sub -consultants name the District and the Consultant 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. 8.5 The coverages shall be as specified below and the limits of liability shall not be for less than the amounts listed below except as may be specifically modified elsewhere in the Contract Documents: Required Minimum Insurance Coverage & Limits A. Commercial General Liability (occurrence form): $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. 27 The CGL insurance policy shall include the following coverages: 1. Premises - Operations Liability 2. Blanket Contractual Liability 3. Products & Ongoing and Completed Operations Liability 4. Contractor's Protective Liability (Independent Contractors) 5. Personal Injury Liability 6. Broad Form Property Damage Liability Endorsement (a specific endorsement may be needed if non-standard coverage is provided) 7. Coverage for explosion, collapse and underground hazards (X.C.U.) 8. Blasting (provided that blasting coverage may be excluded if blasting is not to be performed in connection with the Contract work as governed by the Project Specifications). 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), additional endorsements may be required. The CGL 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. B. Business Automobile Liability $1,000,000 Combined Single Limit The policy must cover all owned vehicles including hired, non -owned, and leased vehicles used in connection with the work. A MCS-90 endorsement shall be included on the Policy when required by Missouri law. C. Workers Compensation & Employers' Liability 1. Workers Compensation: Statutory Limit Workers Compensation 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. 2. Employers' Liability: $ 500,000 Each Accident $ 500,000 Disease Each Employee $ 500,000 Disease Policy Limit 28 D. Excess (Umbrella) — applies to CGL, Business Auto & Employers' Liability Excess (umbrella) coverage must be provided for Commercial General Liability, Business Auto and Employers' Liability coverages. These limits are in addition to the primary limits set forth above. For Contracts $100,000 & Over: $2,000,000 Each Occurrence $2,000,000 Aggregate For Contracts Less than $100,000: $1,000,000 Each Occurrence $1,000,000 Aggregate E. Pollution Liability $2,000,000 Per Claim $2,000,000 Aggregate The Consultant or its sub -consultant if providing or performing subsurface or geotechnical services and/or landscaping shall carry and maintain or shall require their sub -consultant performing such services to carry and maintain in force for the full period of the Contract, pollution liability insurance covering losses caused by pollution conditions that arise from the operations of the Consultant and/or the sub -consultant. 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. The pollution liability insurance coverage if provided on a claims -made basis shall be retroactive to the earlier of the date of this Contract or the commencement of the Consultant's work on the Project, and Consultant shall cause the same to remain in effect for a period of at least five (5) years (two (2) years if contract less than $100,000) 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. F. Professional Liability/Errors & Omissions $2,000,000 Per Claim $2,000,000 Aggregate Consultant shall maintain in force for the duration of this Contract errors and omissions/professional liability insurance appropriate to the Consultant's profession. Coverage as required in this Article shall apply to liability for professional errors, acts or omissions arising out of the scope of the Consultant's services as set forth in this Contract and the Project Specifications. The insurance coverage shall be retroactive to the earlier of the date of this Contract or the commencement of the Consultant's work on the Project, and Consultant shall cause the same to remain in effect for a period of at least five (5) years (two (2) years if contract less than $100,000) 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. 29 NOTE: If Consultant 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. 8.6 Deductible/Self-Insured Retention: In any coverage a deductible or retention that exceeds $100,000 shall be noted and approved by the District's Risk Management Department. The District reserves the right to review the funding for any such deductible or retention program. If self -insured, the District reserves the right to request acceptable proof of financial responsibility before approval. 8.7 Cancellation Should any of the required insurance coverage be cancelled prior to the expiration date, the Consultant must provide at least sixty (60) days written notice to the District prior to the cancellation. For policy cancellation for non-payment of premium, the Consultant must notify the District at least ten (10) 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 Consultant to notify the District of any cancellation or non -renewal and provide the District 60 days' notice. 8.8 Replacement Policy Upon receipt of any notice of insurance cancellation, termination or alteration, the Consultant shall procure other policies of insurance identical in all material respects to the policy or policies about to be cancelled, terminated or altered and shall provide the District with evidence of coverage before the alteration, cancellation or termination date; and if Consultant 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 Consultant without notice to Consultant or may elect to pursue any other remedy permitted by law or the Contract terms, including but not limited to termination of the Contract. 8.9 The DISTRICT requires by contract that the DISTRICT, CONSULTANT and SUBCONSULTANTS be made additional insured(s) under the General Contractor's General Liability Insurance Policy. 30