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Home My WebLink AboutBid/Contract 'I FROM :JTL. Inc. FAX NO.:812-288-6656 Mar. 18 2008 02:39PM P4 /' r_~ ~~~""af..-~ Fcm No.lI8 (AIuIMd ~ CONTRACTORS BID FOR PUBLIC WORK PART I (To be completed for all biCIS) (Plel" type or print) ~ight Street ~mergenoy seWer Rehabilitation Morris Street to shor~ Jaokson Street , WI..J l!b.... .. .h...- .m. Job No. 07159 Date: January 22, 2008 1. Governrnental Un. (Owner):. City of Jeffersonville 2. County:_ w _ Ctark 3. 81dc1w (FIrm): !l'll!lituform Technologies USA, Inc. Add...: _17988 idiflon AvenUe f c~ Chesterfie~d, MO o~oos 4. TaIIIphoneNl.tmb8r: 6!6-530-~OOO 5. Agent of 8tdder (If applk:able):"..,..N IA PUl'lU8nt to notices given, the underIignecl Offers to fumilh I8bor and/or matnl n...-y to complete r thlpublicW0fk8projectof City of Jefferso~.ville, :tndiana (GcMKnmentaI Unit) In accardInCI With pI8M and .peclIcatIons pn!IpWed by Jacobi, Toombs, and Lanz, :r.nc . 120 Bell Avenue, Clarksville, IN ~7129 and dated January, 2008 .. for the sum of ,,,..,, 1I..........J.r"4] (:;;Y.... #o....<"'-r.-t.J l I ~ ty-'t"'- ~~~'n~ ot;;e......l!.""l.,. lP,""c d.o\\Ilk~~ ~~W -;:;;.$ 20'-\ I ~ ~ \ . 00 The underlignld furtlw -.g,... to fwTlilh a bond or certlftIId chllCk with thl& bld for an .-nount specified in the ttOliCe of am. leaIng. tr 8l8matIYe bfda ~I th. US'ldnlgned Umit8 a tmlpaal for each In accardance with the natlce. Any addendume d8ched wit be IPfCificalIy referenced It the appRcable page. tt IIddIIIonaI units of ~ Induded In ~ contract.... needed, the COlt of units muat be thlt 88m8 al I'II1t lhown In the orIgln&l contrEt If ICCept8d by It1e Govemmentll Unit If the bid II to be ...".,... on a una b8IIl, the I8miZ8lfon d1he Llnb 8hBn be shown ~ a aeparatlIllttaehrnent. The contIlCtor and his subcontractor8, If 811)', shill not dilcrtmlnate againat ot intimidate any 8fI1:Jlayee, or IPPICImt for employment, to be employed in the performance of thiI contract, with reepect to "" mMt8r dlrdy or lndInIctIy IW.t8d to empICI'fIMht bec8uIe of race, religiOn. color. 18X, national oI'igin or anCHtry. BrECh af1h11 coveMRt may bIIl'IQMIId BI a ,..rfal bnlBch of tMc:ontr1ld:. CERTIFICATION OF use OF UNIiED STATES STEEL PRODUCTS . (If appIc8ble) I, the undenIigned bfdder or agent . . contractor on a public WOfk8 project, undlrlt8nd my stBlutofy obIlOltIan tG "" ... pr0duet8 m8de In the J,lnlted stIlteo. t.e.. 5-16-&-2. I hereby certify 111m I .nd .11 IUbcclt'Inckxa employed by me for tN. project wi UI8 u.S. ..., produca on 1h18 project if IIW8rded. I undenltlltcl that YIoIIlionIhereundlll' may result In forfelture d contnlClual payments. 8-102 ""- FROM : JTL, Inc. FAX NO. :812-288-6656 Mar. 18 2008 02:39PM P5 ,., I' t The 8bOV8 bid IIICC81*Kt \hlI faIlowlng condltlaM: ACCEPTANCE 1'2> 1:! day d ItA 4 tv"'^- - tvO,..".;e - .'Z-Q)() " 0 ,1UbjeCt to the .J.e,.~oNllLLtL ~ ~I ;(fI::;. { 0!/A./# - L<.M - ~ ,,'" '( .oW, MQ".W 'i. Jd~TI1 (COmP_.edIon8 I, II, III, _ IV for all ebIt8'....1oo8I public worb projeda .. nlqulrecl by statutee Ifprajeclll one huncnd \ttOUIII1d doUa (1100.000) or mote. (Ie 354.12-4) Goft.'....... Una: City of Jefj:ersonv.i.ll~ Itdder (Finn) Insituform 'technologies USA, rpc. Date: Jii1nuary 22, 200B (\, -n..~ to blsubmitted un.. oath by tIdICh bidderwlth .net .. a part of his bid. AUaCh addldon8l peges for eac:h -=tton .. nelded. SECTION I EXPERIENCE QUESTIONNAIRE 1. 'Mwt public worb protecI:w h88 ~r ~ completed for the pet10d of OM (1) yerar priot to the dIM of th8 CUINN bid? Contract Amount C"of~ ~ Name rand ,AddreA of Owner $ 64.714,.00 IllsitufOrl1l 2007 South }l:aven Sewer \fork" 'ValOe.:r:a $ 74,298.00 Inl'litufOI:l1l 20Q7 C~ty of Evansville. IN $705,116.50 !Ilsituform 2007 City of Beech Grove, IN $166,437.50 :!Ilsituform 2007 Town of Cicero, IN so, IN 2. lM'Iet public __ pcqeds ... now in ptcC811 rj COI'IItruCtiOn by your OI'QIM\iZation1 VVhen to be COt'ltrllCt ~ c_ at V\ICJrk Ccrnaleted Name and Add..- of ~ $179,6:;10.00 In8it~form 2008 Peru Utilities. I~ $615,150.00 Ins1tuform i 2008 City of South Bend, IN $415.205.00 Insituform .:l008 City of Fort. Wa.yne, IN $796,483.00 Insit\Lform 2008 TOwn o~ ~olcott, IM f\ /. B-103 '~: 00 I 0 i 0 C\I \\I ! J:I c en ~ l- t) u W .:: -, H 0 ~ ~ 0::: a. p (j) 1 0::: ~ LL rl U. (J) L!l rl F'\ 0 (j) 0 0 0 -rl 1 -rl 0 0::: ? C ' tJl (j) (") LL .:: a: C 0 \.D ~ 0 -- ::J Sl - rl .:: (J) C\I 0 0 H II) .:: (j) ~ (j) C\I d ..c: ~ ~ >. z u t) ~ H E (j) .:: 'd (j) ::J C E-< rl :::i t-:l ~ 0 0 (j) nl II. S (J) -rl II) ~ .:: S -rl nl H 'd ~ ::> 0 t-:l 6 0 H ~ IYl (j) a. >. ::J 00 .jJ .jJ ~ ~ .jJ 00 (J) -rl -rl m (j) U u: (J) r-- ..c: .:: .--! u H r\ 8-107 """ TO THE BIDDER- The following Foan 96a is not required by the State Board of Accounts. However, the bidder must either use this foan or one similar to it prepared by their accountant. >...." JACOBI, TOOMBS AND LANZ, INC. S:\Sydney\WPDOCSImiIceIIIr1eous\MAS'I'ER\dlv8.wpd B-t08 \J n , / GonmI_ No. 96-a P-.il<d by tho: Sate lIoudof Aa:aInII of Indiana. limed 1949 STANDARD QUESTIONNAIRES AND FINANCIAL STATEMENT FOR BIDDERS Prescribed by THE STATE BOARD OF ACCOUNTS OF INDIANA For use in investigating and detf't:mining the qualifications of bidders on public construction when the aggregate cost of any such work or improvement will be Five Thousand Dollars or more. These statements to be submitted under oath by each bidder with and as a part of his bid, as provided by Chapter 305, page 1248, Acts of 1947. Submitted to City of Jeffersonville --~_..... ................................ ................. .................--........ --... ....... ..................... ................. ........ ........ ..... ......... ............ By ...........................:::.~.~.~:::~.~.~..::::::::~~:~~.~.:.~..~~;:.:...:~:.:........ { =~=~ . ~~ Address .......... .... ..... ........... -..... '" ........ .... ...... ........ ..... .... .......... ................... .......... ...... -.. "'....... ...... .....-.. ........ ........... ....... .. .......... 17988 Edison Avenue Chesterfield, MO 63005 .. .......... ................ ............. ......... ........ ........ .... ............ ...oo............ ............... .o.. ............... _. ..... _. .. .... . .... ..... ... ................... Date submitted January 22 08 ..........-................................................................................................................. 20................. Filed . ........... ......... ........ .......... ............ -........ .............. .... ... ........... .. ..... ............ ....... ...... ..... .......... ............................................................................................................................. .. .... ..... ............ ......... ........ ................ ......... .................. ............ .. ..... ... ............. ...... .......................................-................................................................................................. A.E. BOYCE, M\JNCIP., 1ND S:\Sydnoy\WPDOCS\mIsceIIa.wpd B-109 Submitted by ........~.~~=~~.~.~~:..~.~.~.~:~=.~.:~.~~..~:~:....~.~~:............................................................................ { ~~~ 17988 Edison Avenue, Chesterfield, MO 63005 ~iR~~~ Principal Office at .. ................ ................................................. ............... ............................................................._.......................... .......... . .." ) City of Jeffersonville .. ................ ......... ..... ........ .. .................... .... ...... .... .......... ........ ... .... ... ........... ..... ..................................... ..... .. ...... ........... ........... ...... ....... ...... -........ ......... ........... ............ -..... ......-.. ..... -......... ....... EXPERIENCE QUESTIONNAIRE The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers to interrogatories hereinafter made. 1. How many years has your organization been in business as a general contractor under your present business name? 11 years 2. H~;.;;;~.~y.y~;;.~~~~~~.~.~~~;~~ti~~.;~;k.i;~.y~;;.~;g;ci;~ti~;;.h;~r.(~).~..~.p~~.~~~tt;~t~;;.~d.(b)............. as a subcontractor? ...........~.:..~.~...................~:. ..~~..................__................ ......... .............. .................................................... ............ 3. What projects has your organization completed? ........................................................................................................................ CONTRACT AMOUNT CLASS OF WORK WHEN COMPLElED NAME AND ADDRESS OF OWNER $705,116.50 Insituform 2007 City of Beech Grove, IN ...- .......... ........... ....... ...... ... ... ......... ......... ...... .... ........... ..... ... ..... ...... ........... ........ ..... .... ................................. .......................... .......... ........ .............................................. ... .................. $166,437.50 Insituform 2007 Town of Cicero, IN ........ .. ...... ......... ..... .... .. ..... ............ ..... ........ ........ .............. ........ ........... ............... ....... ........... ...... ........................................................................................... ........... ....... .......... ............. ........... ..... .......... $ 74,298.00 Insituform 2007 City of Evansville, IN 3a. What projects does your organization now have in process of construction? CONTRACT AMOUNT CLASS OF WORK WHEN COMPLElED NAME AND ADDRESS OF OWNER $615,750.00 Insituform 2008 City of South Bend, IN ..... .. ............. ... ............... .... ... ..... ........ ........ ............ .... ..... ...... ..... .... ..... . ....... . ............ ............ ................................................ ..................... ................................ .................... $415,205.00 Insituform 2008 City of Fort Wayne, IN . ...... .......... ......... ............ ....... .... ..... ....... ...... .... ........ ..... .. ......... ..... .... ......... ........ ........... .. ....... ............... ........... ............ ............ .................. ....... .... .............. ............... ......... ...... ....... ........................ $786,483.00 Insituform 2008 Town of Wolcott, IN """" 4. Have you ever failed to complete any work awarded to you? If so, where and why. NO .......................................................................................................................................................................................................................................................................................... .....-...........................................................................................................................................................................................................................................................................................-... 5. H~.~y.~ffi~;.;;-~.~;.;;-f.y~~.~;g;~;ti~~.~~;.b~~~..;;;;.~ffi~~.~;.~~.~f.~.~~~..~th~.~;g;~;ti~~.th~t..f;Ji~d.t~ complete a construction contract? If so, state name of individual, other organization and reason therefor. NO ...........................................oo..............---~..oo.._...._.......................oo...................................................oo.................................................._..........._..........................................................._....__......_~_.....................oo.._...................oo..............._ 6. H;.~y.~ffi~~.~~.p~~..~fy~~.~;~~~ti~.~.~~~.f:ill~d.t~.~~~pi~t~.~.~~~~~ti~~.~~~tt~~t.h~di~~i"~.hi;7h~;.~:;~ name? If so, state name of individual, name of owner and reason therefor. NO ....... ...... ............. ..oo.............. .......... ........ ..... ..... ........... ........... ....... ..................... ................... .... _...... ..oo... .... ..... .............. ...............oo........ ..oo...... .... .................... ................... _...... ............ ................. . ............ . . ... ..._ ......... 7. fu.;~.t.~th;;~~~..~n;~~~;~..~~.y~~.ifu~ci~.fiy.~t~;~~t~d?m.............m.........................._....................................................... NONE ..............................................................................................................................................................................................................................................................................................................."'...........-..................... ..........................................................................oo...........................................oo........oo...............oo.............oo.................oo.................................................................................................................................................................... '...I S;\Sydney\WP~STER\dWB.wpd B-ll0 8. For what corporations or individuals have you performed work, and to whom do you refer? Abbott Laboratories Wade Osborne 847-935-5598 .. .......... ........ .._.............. ......... ....... .... ..... ............. .... .... ...__......... ..... ............. ...... ........ .......... .... ....... ..... ............ ........ ... ... ............ .................. II.. .... ....... ........... ............ --...... ........ .......... ............. ........ ....... ... ...... .....s:?HE:?S?..l?.l;:,~g.~R.~........... ....... ......S1.~;i;.r;...?~g!?-.~~...................~.~.~.:~.~.~.:.?.?~}...... ... ..................................................................... ..... 9.!AE...~Q:r:;r>.9.:r.i:'!J;.A.9.u .... ...................KEil.;J.ly...R;i.~b.......................l?J.!L...tJ.~.~. :.?9.'J.~....... ........ ....... ........................................................ ......... ... ........... .... ... ... .... ... ...... ....... ... ........... ....... .............. ............ .... ... ..... .. .. ....... .... ... ......................... ....... .... .... ... ............. ............. .... ......... ........................... ....... ... ........... ...... ........ ...... ...... ............ ...... ... ......... ... . ..... ... ... ..... ............. .... .... .. ..... ................. . ... ........ ... ..... .... ... ..... .. .. ....................... ............ ......... ........ .................. .... .. ........... 9. For what cities have you perfonned work and to whom do you refer? See Attached ...................................................................................................................~......................................................~................................................................................................. . .... . ......... .... .... .. ............ ....... ......... ....... ...................... ...... .... ...... ... ........... .............. ...... . ......... ...... .... ......~ .......... ........ ....... .... ...... ....... ..... ......... ............ .............. .. ............. ................... ......... ..... . .... ..... .......... ... ........ .... ............ ........ ........ ........... ..... .......~... ................ ................ ........... ............... ....... .... ...... ........ ........ ..... ............. .... .......~............ .......... .... ........... ... .. ........... . ...... .................. ........ ..~.......... ................. ..... .......... ...... ......-...... ...... ....... .. ............. ...-............... ............ ...... ..... ... ......... ....... ......... .... .......... ................ ..... ....... .................. .... ......................... ..... .................. .............. ..... ....... .... ...... ................... .... 10. For what counties have you perfonned work and to whom do you refer? See Attached ......... ................... ..... ........ .............. ...... ................... ...... .... ......... ........ ............... ......... .... ... ...-....... ....... ..... ..... .................... .... ............ ......... .... ....... ........ ...... . . ......... .. ..... ..... . .... .... ............. ..... ....... .......... ........ ... ....... ........... ........... ......... ............. ..... .... ........ .... ....... ................ ........ ............... ... ........ ...... ... ................. .... ..... ........ ...... ..... .............. ............. ..... ....... ......... .... ........... ..................................................................................................-............................-....................................................................................................................................................................................... ............ ...... ..... .... ....... ....... ......... ..... ................. ..... ....... ....... ............. ..... ............ ..................... ........... ............. ....... ...... ....... . .............................. ......... .... ....... .-. -.. ........ .......... ..... .... .... ............ ...... ..... ........................................................................................................................................................................................................................................................................................... .. ......... ....... ..... ............. .......................... ....... ........... ............... ..... ..... .. .......... ... ......... .... ....... .... ........ ..... .... ...... .... ....... ... ........ ..... .... ............ .......... ...... ...... ..... ......... ............. .......... ...... ............ . ........... ............ ...... 11. For what State bureaus or departments have you perfonned work and to whom do you refer? See Attached . ...... ... ............... .. ............. ... ..... ................... ................. ......... ... ........ ............. .............. ........ .............. .... ......-. ............ ....... ......... .............. .................. .......... ........... ~ .......... ............. .... ...... .. ............. ..... ... ... ............... ............. . ...... ................ ............... ......... ...... .... ........ .............. ......... ........ ... ............. .... ............... ............. .... ...... ......... ........ ........... ............... ..... ................. .................. ......... ................ ........ ..... .... ..... ........................... ...... . ...... ............... ............ ........ ......... .. ..... ...... ........ .... ......... ...... .............. ......... .............. ................ .... ........... ......... ............... . .................... .............. .......... .... ... . . ........... ... .......... .... ....... ........ ........... . ..... .... ..... ..... ....... ......... ... .... .... .... . ........ ... ... ..... ..... ... ....... .......... .... ... .. ... ....... ....... ..... ...... .... .......... ........ ...... ... ....... . .......... .. ....... .... ....... ... .......... ..... ........ ................. .. .... ....... ........ ........... ..... ...... .......... ... ..... .... .... .... .... .... ...... ....... ........ ..... ...... ..... ...... ... ............. . . .. ......... ... ................. ... ..... ............ ....... .. ..... ..... .... . .. ... . ... ...... .............. ... ......... 12. Have you ever perfonned any work for the U.S. Government? If so, when and to whom do you refer? Yes, see attached. .......................................................................................................................................................................................................................................................................... r: ........................................................................................................................................................................................................................................................................ "~~ ................................................................................................................................................................................................................................................... . .... ..... ...... ....... .. .... ..... ........ ...... ................... ..... ....................... ............. ........... ....... .... .... ....... ...........'O ... ........ ........ ....... ........ .... ... ...... ... ....... . . ........ ............. ........... ..'O ..... .... ....... ...... .. ....... INDIVIDUALS NAME .. ..... . .... ....... .... ............ ...... .... ...... ....... ...... ..... ...... ...... ................ .. ........ ..... .......... ........... .... ......... . ..... ............... .................. ....................................... ............. ........ ......... . .......... ..-............. ...... .... .... ...... ....... What is the constructIon experience of the t rincioal individuals of vour otRamzatIon? YEARS OF CONSTRUCTION EXPERIENCE PRESENT POSITION OR OFFICE MAGNITUDE AND IN WHAT CAPACITY lYPEOFWORK 13 ....................-............................................... .......................................... ................. ......................... ..... ............ .......... .......... ............................................... .............. ......................... ..............................-.. ..... H. Douglas Thomas Vice President 43 operations/Mngment PM, GM, VP Thomas Vossman SrVP & COO 23 Const/Mngmnt/Ops PM, VP, COO ............................................................. .......................................................... ........ ............. ............... ........... .................. ............ ......................................~ ._~.. ...... .............-... ...................................................... David F Morris SrVP & CAO ..~.?.......................... .......... .~::g~.y.~~?~g::~.:.::~....... . ."!!? !..~.~:::::;:.~.~.':.::!.~~.?....... .... ......... .... ........ .... ....... ......... ......... ...... . ........ ................. .............. ............... ...... ...... ...... ............ .. .. ...... .... ... . .. .... ... ............ ............... ......... .... David Martin VP & CFO 18 .~~ ~~E.':.~.!.~~~~.~.~.~~~ !:... ..Y.?L.C:.~?. ...................... ..... ..................... ......... ...................... ............... ................. ................ ................................................... ........ ...... ........... ......................... ............... .......................... ............................. ....-........... .. ................ ....... ................. .......... ..... ............. ............... ............ ................... ............................. ........... ............................................... ............... .........................--......... .......................... ....... ...... ............... ............ ..............-............... ....... .......~........................ .......-. ....-.~... .........- ..... ......... ..--................ .................................. ......... ........... ................ ........................... ................. ............... .....~.............. ....... . ....... .............. ....... ......................-.............. .......-................. ..............~........... .......~................ .........~~.~_...................-.......... ........................... ....... ..................... ........................ ........... .. ...............-...... ....... ........ ............... ....... ................ ..................................... .............. ................................ ................... .... .......... .-.... ........... ......................-.......... ............. .......... ................................. ............... ..................... .... ..................... .................... ................ ..... S:\Sydney\~ASTER\dtYB.wpd B-111 PLAN AND EQUIPMENT QUESTIONNAIRE The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers to interrogatories hereinafter made. In what manner have you inspected this proposed work? Explain in detail. ........ ...........................................~;~......!:-:::.I..~5::::~:t? .............. ................. ....................... ............... ................................. ..... ,." .......................................................................................................................................................................................................................................................... ............................................................................................................................................................................................................................................ ..........................................................................................................................................................................................................................................-.............................. ....... ...... ...... ...... ...... ....... ........ ....... ........ ..... .......... ....... .......... ... ........... .............. ....... ........ ....... -. ....................... ........... ...... ...... ........... ........ ......... ....... ....... ........ ...... 2. Explain your plan or layout for performing the proposed work. SE'"E A--t-A:c~b ....... ............ ....... . ........... ... ... .... ........ ... ...... .. ..... .... ...... ..... ....... ......... .... .......... ....... ........ . ....... ..... .... ....... ... . ........ ....... ........ .... ... ....... .... ......... ..'O'O.......'O ....... ... ...... ... . ......... .'O...... ... ...... ......... ... ......... ....... ..... ......... ........... .......... ... ....... ............... ....... ....... .... .... ...'O. ..... ..... ..... .................... ........ .... ..... .... ..... ....... .... ....... .... ........... ....... .......... ..... ......................... ..... ........... ....... . ....... ............... ........ . ......... ........ ................ ........ ........... ......... ..... ...... ....... ..... . ...... ...... ......... ............. ...... ...... .. . ............ ..................... ..... ... ...................... ......... ........ -................ . ......... .......... ........... ......... ........ .... ..... ............... ......... ... ...... ....... ...... .................... . ......... ..... ..... .... .... ... .. ..... .. ... ............... ...... ........ ..... ..... ..... ................... ......... ............ ......... ....... .. .......... ..... .......... . ......................... ........ ............. . ... ................ ...... ....... ..... .......... ....... ....... .... ..... ....... ............ ........ ....... ........... ............. ..... ................. .............. ...... ...... .... ....... ...... ..... .. ..... .... ........ .....'O................... .... ............. .............. ... .. ..... .... ..... ...... ... ... ...... ..... ..... ........ ............. .............................. ...... ...... .... ............... ....... .... .......... ......... ...... .......... .... ....... .. ... ..... ................ ........... ........ ........ .......... ..... ........ ... ........ ..... ... ..... ........ . .... ... ............ .... ... ...... ......... .... .......... ... ................. ... ............ ............. ..... ... ...... ..... .... ...... .......................................................................................................................................................................................................................................................................................... . ..... ........ ....... .......... ........... ........ -.... ................. ........... .... .. .... ......... .... ... ........ ........ ... ...... ............. ...... ......... .... ...... ........ . ............... ..... .... ........... ......... ..... ......... ....... .....'O..... ...... . ..... ........ ... .......... ...... ......... ...... ........... . ......... . ........... ....... ............. ......... ....... .... ... ..... ....... ......... . ... ..... .......... .... ....................... ....... .... ...... ..... ..... ..... .... .... ....... ........ ..... ......... ............. .. ......... ...... ..... .......... ... ....... ........ ... ........ ... ... ........ ........................... ................. ........ .... ...... .......... ... . ..... ........ ............. ....... ...... ... ... . .... ..... .... ...... .... .. .......... .......... ... ......... .. . ..... .... .... ........ ...... ..... ... .. ............. ... ........ .. ........ ......... ...... ......... ... ...... ... ...... .... .... ....... ........ ....... ...... ..... .... .................... ............... ......... .... .......... ........................ ...... ........ ...... ......................................................................................................................................................................................................................................................................................................... 3. .........................................................................................................................................................'O.............................................................'O................................................. ~~:.;;:1~-~~"'::.~~~~~~.~~~;r.:.t..:.;~~~_b:.~..2o.~~e.';j2.~~.~5.1!...__.....,.t *...D~..y~;;.~t;~d..t~..d;;.th~..~~i~g.~;;.th~.p;;;p~~~d..;~~..~th..y~~.~:;;;..f~r~;;?..iT;~:..gi;~.~~~t..~~d..tYP~..~f equipment to be used. IVI/4' . ..... ..... ...... ... ............. ...-.-.. ....... ........... ........... ... .......... .... ... .... ........ ............. ..-.... ....... ........... ..... ..... ... .......... ...... ............ ...... ........ . ... ..... ................... .......... ................ ............ . ...... 4. 5. .. ......... ......... .-..... ............. ......... ........... ....... ....... .... .... .... ............... .... ... .......... ................... ...... . . .... ...... .. .......... .............- ..... ........... .. ................. ............ ............ ....... ............. .. .... ...... * If you intend to sublet the hauling or perfonn it through an agent, state amount of subcontract or agent contract and, if known, the name and address of subcontractor or agent, amount and type of his equipment, and financial responsibility. ... ........... ......... . ...... . .....f:":!..L.. '!!!.. n....... .... .... ........ ........... ...................... ......... ... ....... ................. ... ..... .. ....... ...................... ..... ...... ........... ... .............................................................-......................................................................................................................................~...............................................................................-........-........... .... ......... ........ ... ...... ............ ... .... ....... ..... .... ... ...... .... ....... ..... .... ............ ..... ....... . .... ... .............. ..... ....... ...................... ...... ..... ..... ...... ....... ............ ... ... ...... .............. ....... . ....... ... .... ..... ....... .......... ........ ..... ........... ....... ..... ..... .. .... .... ......... .......... .... .. ..... ..... ...... ............. ....-. ..... ...... ... .......... ... . ............... .......... ..........-..... ....... ...... ....... .... ........ ...... .... ........ ......... ..... ... ................ . . -.... 6. * Do you intend to do the grading on the proposed work with your own forces? ........................ ...... ....d..I. !!!::........... . .... ... ...... ..... ........... ..... ..... .......... .... ........... ..n... .. ....... .... ......... ....... ............................. ........... ......... .........................................................................................................................................-...........................................................................................................................................-.................. ..............................................................................................................................................................................................................................-................................................. ....-................................................................................................................................................................................................................................................................ ..... i.'.i:S:'6";;,d' 7.;;;y..;;,c.!;..;pp~i,i;.;;;o~~.Yi~-.;;,;:............................... ........... .... .......... .... ...................... ............... ........................... \'ItI/fi1 S:~WPOOCS~RldJy8.wpd B-112 r\ ! (\ Attachment - PLAN AND EQUIPMENT QUESTIONNAIRE 1. In what manner have you inspected this proposed work? Explain in detail. Mr. Bill Seibert, General Superintendent, visited the site and completed a walk through prior to preparing our planned layout for the project. Manhole lids were removed in order to gauge the flow in the lines to determine bypass pumping requirements and to verify the pipe sizes. Traffic control was also taken into consideration as well as the set up of our proposed equipment. 2. Explain your plan or layout for performing proposed work. Perform inspection services and develop SSES report. Set up traffic control and bypass pumping as required, clean and televise pipeline to prepare for installation. If any point repairs are required, notify the Owner or Engineer. Wet-out the Insitutube with resin, set up equipment at site, install the Insitutube and cure. Restore services and flow. Clean Manhole walls amd apply manhole lining product. Clean-up site. ~ Insituform Thchtwlogie.."l" llS'A; lnc. STANDARD QUESTIONNAIRES AND FINANCIAL STATEMENT FOR BIDDERS 9. For what cities have you performed work and to whom do you refer? Name Reference Phone Ci :v of Evansville, IN Ardell Smith (812 ) 421-2130 Ci :y of Wheaton, IL Paul Redman (630 ) 260-2000 Ci :y of Fort Wayne, IN Mike Hicks (219 427-1160 Ci :y of Markle, IN Greq Sauter (219 758-3386 10. For what counties have you performed work and to whom do you refer? Phone (847) 680-1600 913 681-3200 (630 682-7000 .. For what state bureaus or departments have you performed work and to whom do you refer? Reference Victor Modeer Tom Faulkner Phone 12. Have you ever performed any work for the U.S. Government? Yes If so, when and to whom do you refer? Name Reference U.S. ACE (509) 577-3356 U.S. Air Force Offut Air Base (797) 697-7376 U.S. Army Newport Chemical Depot (765) 245-4403 U.S. Navy GL T Naval Base (847) 688-2311 7. * If you intend to sublet the grading or perform it through an agent, state amount of subcontract or agent's contract and. if known, the name and addIess of subcontractor or agent, amount and type of his equipment and fioaocia.l responsibility. . ......................................... ........ ...............~.L..&... ....... ......................... ................................. .......................... .................................... r) ,,/ .... .... ..... ... .......-...... ... ............ .... .......... ........ ..... .... ......... ......... ........ ............. .... ..... ........ .. ..... ....... ... .. ... .... .. .............. .... ... ...... ..................... ..... ......... .... ....................... ...... .. ... ....... ..... ... .............. ... ....... ....... .... ....- ... ...... ...... .. ........ .. ......... ... ....... ...... ... ..... .... ..... ........ .......... .... .............. ..... ....... ... .. ..... ........... ....... ... ....... ..... ... ....... ......... ................ ....... ................. ....... ..... .... .......... .................... .......... ............... ......... ............ ...... ....... .........~.... ..... ....... ~~.. ..-... ........ ...... ...... ........... ......... ............. ... ............ ........... ........... ............... ......................- ....... ...... ..-- ...- ... ........ 8. Do you intend to sublet any other portions of the work? If so, state amount of subcontract and, if known, the name and address of the subcontractor, amount and type of his equipment and financial responsibility. .... ....... .__......... ... ...... ... .......... m' .......... ..N.I-..I!t...... ..... .......... ... ..... ........ :..... .-. .................. ....... ..- - .... . .-- --. ........ ....... .............. . .....- -... ...... ... .............:...-................................................................................................................................................................................................................................................................................................. ..............................................................................................................................................--..............................................................................................................-...... 9. F~~~.;.hi~h.;~b.~~~w:~t~:;.~;.~~~.d~.y~;;..~;p~~t.t~.req~.;.b~d?......................................................._......................... . . .... .... ...........-... ........... ........ ... ..... ........ ...!.!... (.. ~. .......... .............. ... .... ....... ............ .............. ............... ... .............. ........ ................ ........... ..... .-... ................ ..... ....... ......... ... ... .... .... ...... ...... ........ ............ ....... ..... ....... ......... .....-........ ..... ..... ...... .... ...... ..... ... . ... .... ....... ......... . ...... ............ .... ................ .-.. .............. .... .... . ..-........ ...... ...... ...... ...... ........- ...... .............. ... .... ......... ........... ... ........ .......... -....... ..... ....... .................... .... ....... ....... .. .............. ..... ..... ........... ... ........... -......... ........ ......... ...... ....... . 10 Wb;:t.~q~;:;;~~t.d;;.V~~.;;~.th;t.j;.;;;n;bi~..f~~.th~.p;~p;;~~;f;~~k~..m............................................................-..................... DESCRIPTION, SIZE, CAP ACI1Y. ETe. ITEM CONDITION YEARS OF SERVICE PRESENT LOCATION QUANTI1Y See Attached .... ..................................... ................... ..................... ........................ ............... ..... ............................. ..... ........... ............................. ...... .......................... ..... ...... ......... .............................. ............ ................ ........... ................ ................... ...... .................... .................................... ............... .... .................. ........................... ... ................................-....... ....... o .... ......... .............................. ........ ............-..............-........ ... ..............-............................- ............. ......................... ........ ......... . ..-................ .................... ....... ...-........................... ...... . ....................................... ...... ........... .................-...... ... - ...............--............................--...... ....-................. ..... ...................... . ..... ............ ..... ..... ................ ... ..................................... ..... ...... ..... .................. ....... ........ ..................... ........................... ....................- .... .......-..--................... ............................ ....................... ............ .................- .......................... .................~............... .. .......................-.... .--........-.-........... ..... ......... .......... ....... .....-........... ..................... .............. ............ .............................. .................. ................................ ...... .............. . ........................ ...... ................ ... ................................................- ............ .............................. .... ............. ....................... ................... .......... ... .......... .... ..... ........ ........... ............... ....................... .................... .... ............. .......... ..................... ..... ........................... .............. ........ .........-...................-..... ............................................. ....... .......... ....... .................... ..... .......... ......... ..................... .-......... ............ .............. ......... .......... .... .. ... .... ...... .... .. .... ..... ... ....... ... ........ ...................... ......... ....... .. ......... ... ............. ... ..... ... .-. .... ........... ............ .... ........ ........ . .. ..... ... ....... ........... ............... ...... ... .... ...... ....... .... ...... ......... .......... ... .. ........ ....... ....... ... .... .... ....... ..... ..... ......... .......... ...... . ....... -..... ... ........ .... ......... ....".. ..... ......... ..... .. . ....... ..... .......... ........ ... ........ . ...... .. .. .... . .... .......... .. ..... .. . ....... .. ..... ........... .. .. ...... ...... ............ ........ ......................................................... .......... ...................... ............ ............ .......... ............ ........ .... ............................... .......... ................ ........................... .............. .......- ............... ....-...................... ..... ........ ..... ................................ ............. ........ ............................ ..... ........................ ..... ............. ......... ..................-........... ........... ........... .... ..........................-................ .. ................... ........ ................. ............ .......................................... ........... ....... .... .................................. .... ... ...................... ...................... ........... .................. .......... ......... ....................~. ....... ......~................ ....... . ............ ......... ...... ........... ............. s:\SydnIlJ\~iYB.wpd B-113 11 What eQmpment do VOU Intend to purchase for use on the proposed work, should the contract be awarded to vou? APPROXIMATE COST QUANTI1Y ITEM DESCRIPTION, SIZE CAPACITY, ETC. ...... ..... ............. ..... ... .... ........ ........... ..... ....... . ............. .t!:.. J/'S:::.. .... ........... ... ...... ...... .... .............. ..... ...... ....... ...... .... ...............................:~ / ... .... ..... ........ ......... ...... ......... .... .. ......... ........ ...... .. ....... .. .... ..... .... ......... ..... ...... ...... ........ ....-... .... ...... ... ........... ......... ..... .......... ............ ....- ..-- ........... ................-.. ................... ....................... ............................. .......... .............................. --............................................-----........ .................----.........................................-.....-... ......................................... .-.... ......................."............. .............................. .......... .......................... ......... ................................................. ......... .......................................... .... ............. .... ........................................ ..... ...... ........ ........ ............. ....... .................... .... ........ ......... .......... ............ .. ...... ...... .. .-....... .......... ..... ......... ....... ......... ....-..... .......... .. ..... ..... ............ ...... ...... ...... .. ..... ......... .... ........ .... ..... ...... .... .... ....... ............................. ....... ...... ......... .......... ........ ... ... ..... ....... ..... ..... .... .... ......... .... ...... ...... ... ..... ............ ..... ... ...... ..............oo....... ....... ........ ........ .............. ..... .......... ............ ..... ................................ ..... ....... ...... ...... ........... ............ ......... ....... .... .. .............. ......." .... ... ....... ..... ...... .... .......... ...... ..... ........... ..... .... ...................oo ....... ... ......... .... .......... .... ...... ........ . .. .......... ... .... ................... .......... 12. How and when will you pay for the equipment purchased? . ....................................n.._.................~.Lfr............................................ ............... .......... .................................................................... 13. D~.y~~.p;~p~;~.t~.~~~t.~Y-~9~P~~t.f~~..tbi;.;~~k?.iT~~:.~-;:t~.tYP~.:.q~~tity-;;;d.~~;;;~~~.f~;.~~~tfug.......................... .'::/..f..f..;-::I'C.~'..{k~...C9.~:b:-.~J....J&~&.~$.o+~~y.~~~~..~.~.:?-.~.4~.~~~...t~~.~......f:x;......~~:e.~~:............ :i?~..~~.,....Q.~::.:.....'C.~.~......~.'!:......~~:.::....~~~....~...4!?......7.f?...J.g.k.:-............................................. ......... ............. ............ ..... ........... ......... ....... .... ...... ............... ... ....... ..... .... .. ...... .... ..... ........ ........ ....... ......... ........ ... . ............. ......... ...... .. ........... ............... .... .... .... ............ ... ...........................................................-..............................-......................................................................................................................................................................................................................................... 14. Have you made contracts or received firm offers for all materials within prices used in preparing your proposal? Do not give names of dealers or manufacturers. . ..... n. ......... ........ ............. "~f.. ~?. ...................................... ....... ....... ..................... ......... ... ... ................... ........... ............... ....... ........ .... ....0... /\ . ..... ......... '.' ..... .0..... .......... .................. ..... ...... .............. ..... .... ... ........ .............. . ....... ..................... ......... ...... ....... .... .... ........ ...... ............... } Dated a t ..~~.:.~.::::~.~.:.~.~:...~?......m....... this . ..... ~~~.c:.. ................ ............ day of .. ..~ ~::~:::!.'...... ........ ......................... 20 .......~.~........ Insituform Technologies USA, Inc. ................ ......... ................ .~..;f". .....,.............................. ............... ..... By ......... ~~. ..... ................. .... ....... ........ .......... ....... ....... ............. H. Douglas Thomas, Vice President ........... ................ ..... ..........(f~.~.f"P~s~ ............................. ........ ..... STATE OF .....~:::.?~~:.......................... ) ) SS: COUNTY OF .....~:.:...!:'.?:!.~~........................) ........:::...??~?:.~.~...:.~:?.~.~::................................................................being duly sworn, deposes and says that he is a member of ....:~~.~.~.:::.~.~~..::.:.~.~::~~.~.?~::.~...?~:::....:::.~.:..................................and that the answers to the questions in the foregoing (Name of Osguizuioa) questionnaire and all statements therein contained are true and correct. Subscribed and swom to me this ......~~::.c:..................................day of ........:?:~::~:::y.....................................20 .....?~........m........_.. My commission expires ..!E.~::;::-._.__.._....- i'I Nota y Public ) S:\Sydnoy\wpDOCS\n1IsceIIIISTER\dlYB.wpd B-114 c~ Insituform TeclUl[)/(){!,'ie,~.'" lISA, ln~~ STANDARD QUESTIONNAIRES AND FINANCIAL STATEMENT FOR BIDDERS 10. VVhat equipment do you own that is available for the proposed work? r\! Description Present Quantity Cleaninrl Equipment Vactors 6 Jetters 11 Televising Eauipment TV Vans 18 TV Cameras 44 Insituform Trucks Support 12 Reefers 17 Boilers 14 Water Tankers 2 Trailers 3 Insituform Wet Out & Cutters Conveyors 4 I nsitucutters 36 Miscellaneous Compressors Generators . 14 Static Mixers 3 Hilifts, Dozers, Backhoes 1 Laser 2 Pumps 60 Power Packs 10 Saws 24 Breakers 2 Pick Up Trucks 22 Tractors 6 CONTRACTOR'S FINANCIAL STATEMENT Insituform Technologies USA, Inc. {_~ A Corporation o A Co-partnership o An Individual rubmitted by "..,/ r (', f . 17988 Edison Avenue, Chesterfield, MO 63005 Principal Office at Co,4-'( of ~~e,('Svl)\f i \l-e. To 20 07 C Condition at close of business December 31 Dll ou rs ts. ASSETS 1. Cash: (a) On Hand $ , (b) In bank $ , (c) Elsewhere $ 2. Notes receivable (a) Due within 90 days (b) Due after 90 days (c) Past Due 3. Accounts receivable from completed contracts, exclusive of claims not approved for payment 4. Sums earned on uncompleted contracts as shown by engineer's or architect's estimate o. 1 8 8 9 2 (a) Amount receivable after deducting retainage 4 5 7 8 (b) Retainage to date, due upon completion of contracts 5. Accounts receivable from sources other than construction contracts Deposits for bids or other guarantees: (a) Recoverable within 90 days (b) Recoverable after 90 days " Interest accrued on loans, securities, etc. Other Current Assets 1 7 6 Real Estate: (a) Used for business purposes 2 3 8 5 (b) Not used for business purposes Stocks and bonds: (a) Listed - - present market value (b) Unlisted - - present value O. Materials in stock included in Item 4 (a) For uncompleted contracts (present value) (b) Other Jrulterials (present value) 1. Equipment, book value 7 6 3 9 2. Furniture and fixtures, book value 4 7 3. Other Assets 5 6 7 6 4 Total assets 9 o 4 8 1 6 8 9 I I I -7- LIABILITIES " 6 Doll; s 'iiIoIIiI .( l. Notes payable (a) To banks regular (b) To banks for certified checks (c) To others for equipment obligations (d) To others exclusive of equipment obligations 2. Accounts payable (a) Not past due 9 1 4 2 (b) Past due 3. Real estate encumbrances 4. Other liabilities Billings in excess of costs 5 8 5 5. Reserves Capital stock paid up: (a) Common (b) Common 2 5 1 0 .. (c) Preferred (d) Preferred Surplus (net worth) 7 8 2 4 4 Total liabilities 9 0 4 8 1 7 1. Liability on notes reee 2. Liability on accounts 3. Liability as bondsman 4. Liability as guarantor 5. Other contingent liabi CONTINGENT LIABILITIES I ivable, discounted or sold -,.,r receivable, pledged, assigned or sold on contracts or on accounts of others lities Total contingent liabilities ~ -8- DETAILS RELATIVE TO ASSETS '--' 1 (0) on hand $ Cash (b) deposited in banks named below (c) elsewhere - - (State where) NAME OF BANK LOCATION DEPOSIT IN NAME OF AMOUNT (a) due within 90 days $ 2* Notes Receivable (b) due after 90 days (c) past due DATE OF RECEIVABLE FROM: NAME AND ADDRESS FOR WHAT MATURITY HOW SECURED AMOUNT .. f Have any of the above been discounted or sold? If so, state amount, to whom, and reason r '" I Accounts receivable from completed contracts exclusive of claims not approved for payment , ~ 3* $ AMOUNT OF AMOUNT NAME AND ADDRESS OF OWNER NATURE OF CONTRACT CONTRACT RECEIV ABLE Have any of the above been assigned, sold, or pledged? If so, state amount, to whom and reason 4* Sums earned on uncompleted contracts, as shown by engineer's or architect's estimate: (a) Amount receivable after deducting retainage $18892 (b) Retainage to date due upon completion of contract 4578 DESIGNATION OF CONTRACT AND NAME AMOUNT OF AMOUNT AMOUNT RETAIN AGE AMOUNT EXCLUSI AND ADDRESS OF OWNER CONTRACT EARNED RECEIVED WHEN ~OlJNT OF RETAINAGE DUE IF of assets makes it necessary to show totals , * --Costs & Est. earnings in exce ss of billi pgs 4,419 ><Accts Receivable Trade 14,473 '"", Ketentlon 4,578 Have any of the above been sold, assigned, or pledged?~ If so, state amount, to whom, and reason * List separately each item amounting to 10 percent or more of the total and combine the remaindeL -9- DETAaS RELATIVE TO ASSETS (continued) ..., 5* I Accounts receivable not from construction contracts $ RECEIVABLE: NAME AND ADDRESS FOR WHAT WHEN DUE AMOUNT . What amount, if any, is past due $ 6 I Deposits with bids or otherwise as guarantees $ DEPOSITED WITH: NAME AND ADDRESS FOR WHAT WHEN RECOVERABLE AMOUNT .. 7 Interest accrued 00 loans, securities, etc. Prepaids and other current assets $ 176 ON WHAT ACCRUED TO BE P AID WHEN AMO~- Other current assets 176 8* Real estate (a) Used for business purposes $ 2,385 Book value (b) Not used for business purposes $ IMPROVEMENTS TOTALBooJ< DESCRIPTION OF PROPERTY NATURE OF IMPROVEMENTS BOOK VALUE VALUE l. Land & imnrovempuf-C! 680 2. Buildino-s & imnrovpmpnt-Q 803 3. Leasehold imnrovementc! 902 4. 5. 6. 7. LOCATION HELD TN WHOSE NAME ASSESSED VALUE AMOUNT OF ENCUMBERAN< I. 2. 3. - 4. ~iJ/I 5. - 6. 7. . List separately each item amounting to ] 0 percent or more of the tOlal and combine the remainder. -10- DET AILS RELATIVE TO ASSETS (continued) , 9 Stocks and bonds (a) Listed - - present market value $ (b) Unlisted - - present value lAST INT. PRESENT DESCRIPTION ISSUING COMPANY OR DlV PAID PAR MARKET QuAN- AMOUNT DATE % VALUE VALUE TITY 1. 2. 3. 4. 5. 6. 7. AMOUNT WHO HAS POSSESSION IF ANY ARE PLEDGED OR IN ESCROW, STATE FOR WHOM AND REASON PLEDGED OR n ESCROW J. .. 2. 3. 4. 5. 6. 7. r \ 10 Materials in stock and not included in Item 4, Assets: ".,c';/' (a) For use on uncompleted contracts (present value) $ (b) Other materials (Dresent value) QUANTITY PRESENT VALUE DESCRIPTION OF MATERIAL FOR UNCOM- OTHER PLETED MATERIALS CONTRACTS 11 Equipment at book value $ 7,639 QUAN- DESCRIPTION AND CAPACITY OF ITEMS AGE OF ITEMS PURCHASE PRlCE DEPRECIATION TITY CHARGED OFF BOOK VALUE 11 of assets make it necessarv to reflect totals Machinery & equipment 8.309 4,899 3.410 Autos & trucks 8,432 5,281 3.157 ~.. "",,.- Construction in progress 1 , 078 1. 078 Are there any liens against the above? No If so, state total amount $ . If two or more items are lumped above, give the sum of their ages. -11- DET AaS RELATIVE TO ASSETS (continued) .. 12 Furniture and fixtures at book value $47 ...., 13 Other Assets $56,764 DESCRIPTION AMOUN Due from Parent 43,738 Goodwill 12,235 Other 7~n- I TOTAL ASSETS $ 90,481 DET AaS RELATIVE TO LIABILITIES 1 Notes payable (a) To banks, regular $ (b) To banks for certified checks (c) To others for equipment obligations (d) To others exclusive of Cl uipment obligations TO WHOM: NAME AND ADDRESS WHAT SECURITY .. WHEN DUE AMOUN 2 Accounts payable (a) Not past due $ 9142 (b) Past Due ...., TO WHOM: NAME AND ADDRESS FOR WHAT DATE PAYABLE AMOUN # n-f ~,..,..~"......t-", make'" it necessary to show t-nt-~l,.. 9142 3 Real estate encumbrances (see Item 8, Assets) $ 585 4 Other liabilities $ DESCRIPTION AMOUNT "R-i11-inoc -in of rosts & estimated earnings 585 5 Reserves $ INTEREST I INSURANCE BLDGS. & FIXT PLANT DEPR. TAXES BAD DEBTS $ 1$ $ $ $ $ $ $ 6 Capital stock paid up (a) Common (b) Preferred $ 2510 ...., 7 Surplus $ 78,244 90 481 -12- ~ If a corporation answer this: . Amount for which incorporated rtapital paid in cash ,--,.,/ When incorporated 1983 In what state Delaware Names and titles of all persons having authority to execute and receipt estimate vouchers and to conduct other business for the corporation., including its officers, the signatures of whom are legally binding. Common $ 1 $ 2 ~ 509 Paid in Capital See Attached Do you have necessary "certificate of existence" (or certificate of authorization for a foreign corporation) to transact corporate busines~ in this state, under the terms of Public Law 149, Acts of 1986, and acts amendatory thereto? Yes If a co-partnership answer this: O f .. N/ A ate 0 orgarnzatJon State whether co-partnership is general, limited or association Give the ruunes, addresses and proportional interests of all parties: Name Address Share ""'" $ $ $ $ $ $ $ The name of the partnership finn under which the above partners are operating is Give names and titles of all having authority to execute and receipt estimate vouchers and to conduct other business for the partnership, the signatures of whom are legally binding. -13- 1be undersigned hereby declares that the foregoing is a true statement ofthe financial condition of the individual, co-partnership, or corporation herein f~t rtJuned, the date herein first given; that this statement is for the express purpose of inducing the party to whom it is submitted to award th~ sub~tter a contract; and th/at @!1~ depository vendor or other agency herein named is hereby authorized to supply such party with any information necessary to venfY this statement. It.. ' Insituform Technologies USA, ~ 17988 Edison Avenue Chesterfield, MO 63005 NOTE: A co-partnership must give flJ"ffi name and signatures of all partners. A corporation must give full corporate name, signature of official and affix corporate seal. Affidavit for Individual STATE OF COUNTY OF } SS: being duly sworn, deposes and says the foregoing fmanciaI statement, taken from his books, is a true and accurate statement of his fmanciaI condition as of the date thereof and that th( answers to the foregoing interrogatories are true. Subscribed and sworn to before me this (Applicant must sign here) day of 20 Notary Public Affidavit for Co-Partnership STATE OF COUNTY OF } 88: IirtttJ/1 being duly sworn, deposes and says t he is a member of the fmn of ; that he is familiar with the books of the said firm showing its fmancial condition; that the foregoing ftnancial statement, taken from the books of said fIrm, is a true and accura' statement of the fmancial condition of the said fInn as of the date thereof and that the answer to the foregoing interrogatories are true. Subscribed and sworn to before me this (Member offlffil must sign here) day of 20 Notary Public Affidavit for Corporation STATE OF MISSOURI COUNTY OF ST. LOUIS } ss: H. Douglas Thomas being duly sworn, deposes and says that he is Vice President fth Insituform Technologies USA, Inc. . o e , corporatIOn described in and which executed the foregoing statement; that he is familiar with the books of the said corporation showing its fmancial condition; t the foregoing financial statement, taken from the books of the said corporation, is a true and accurate statement of the fmanciaI of said corporation a~ of the date thereof and that the answers to the foregoing interrogatories are true. 22nd 20 08 // H. Doug l(~cYhmJlMciW; h~~ "' Subscribed and sworn to before me this ..., Notary Public JANA LAUSE No1arY Public - Notary Seal Slate of Missouri Stlouis County My Commission Expires Dee. 5, 2009 Commission # 05805615 -14- EIGHTH STREET EMERGENCY SEWER REHABILITATION, JOB NO. 07159 t' 1 APPROXIMATE DESCRIPTION WITH UNIT UNIT PRICE IN TOTAL AMOUNT QUANTITY PRICE WRITTEN IN NUMBERS FOR BID ITEM WORDS 1482 LF 24-inch Cured-in-Place Pipe Liner For............... ............... .:...... . ...... ........... .............Dollars Per Linear Foot $ ~f),oD $ \ 2-C;-, C)::}D. 00 738 LF 30-inch Cured-in-Place Pipe Liner For..................................... . ................... ........... .Dollars Per Linear Foot $ \00.00 $ i--~ / 8DO. 6D I LS Dewatering for C.I.P.P. Installation (if required) \..,="'" ITEM NO. 2 3 For. ........ ..... ........................ $ \_ 00 ...............................Dollars $ \.00 4 1 LS Traffic Control For................................... .., ....... ....... .... ............Dollars Per Lump Sum $ 6} 000 .0D SUMMATION OF ITEMS I THRU 4 = TOTAL BID PRICE = $ S- () 00 . 00 / $ 2.04 17-:rl.Oo S:\Sydney\WPDOClN1TI07IS'hec:A2.WPD A-207 BID FOR: ..." EIGHTH STREET EMERGENCY SEWER REHABILITA nON MORRIS AVENUE TO SHORT JACKSON STREET JOB NO. 07159 CITY OF JEFFERSONVILLE CLARK COUNTY, INDIANA RESPECTFULLY SUBMITTED, Insituform Technologies USA, Inc. NAM. E~ /./ PERSON H. Douglas Thomas, Vice-president .""" January 22, 2009 DATE Accepted this day of , 2008 SEWER BOARD CITY OF JEFFERSONVILLE, INDIANA Mayor Thomas R. Galligan, President William A. Saegesser, P.E., P.L.S., Member ..., Jeffery A. Caldwell, Member S:\Sydney\WPDOCS\07\071 S9loecA2. WPD A-208 F", ~ DIVISION A - BIDDING REQUIREMENTS SECTION A-3 - METHOD OF MEASUREMENT AND PAYMENT FOR BID ITEMS 1.0 UNITS 1.1 The unit shown for each item on the bid form shall be used for payment purposes. These prices shall be "installed" unit prices. 1.2 Where no quantity is shown for a particular bid item, a unit price shall be supplied, but will only be used where unanticipated extra or deleted work is called for by job conditions and authorized by change order. These unit prices and items shall not be included in the total price shown on the bid form. 2.0 MEASUREMENT FOR PAYMENT 2.1 The unit price for "cured-in-place pipe liner" (C.I.P.P.) shall include mobilization and demobilization, removal and replacement of all manhole castings and cones if required for liner insertion and its associated excavation, backfill and paving replacement, by-passing of sewage, sewer cleaning and disposal of debris at owner-designated dump site, pre and post inversion CCTVI, C.I.P.P. installation, lateral reinstatements, liner sealing at manholes, testing and sampling, final cleanup, and disposal of all surplus material. Dewatering associated with the installation of the C.I.P.P. shall be paid for under a separate item. 2.2 The lump sum price for "Dewatering for C.I.P.P. Installation" shall include all well installation, pumps, hoses, and any and all other items necessary to lower the groundwater, if necessary, to allow the installation of the C.I.P.P. This pay item will only be used if dewatering is necessary (none expected). 2.3 The lump sum price for traffic control shall include all signs, barricades, detour assemblies, cones, barrels, and any other materials, equipment and labor. 3.0 INCIDENTAL CONSTRUCTION EXPENSES 3.1 All incidental construction expenses not mentioned elsewhere shall be included in the appropriate unit prices. S:\Sydney\WPDOCSVJ7ID7IS9lsecA3,WPD A-301 S:\Sydney\WPDOCS\07\07\ S9IsocA4. WPD .-'.' '. DIVISION A - BIDDING REQUIREMENTS vtJ SECTION A-4 - WAGE RATE TO BE ADDED BY ADDENDUM AFTER 01/09/08 Ad &~r"\d~rV\ I A-401 Q.~~;vJ v;~ttt~ \I}o /o~ ..." "'f1tIII f", r'; {\ DIVISION B - CONTRACT FORMS SECTION B-1- CONTRACT DOCUMENTS 1.0 GENERAL 1.1 It is understood that the signature and seal of the CONTRACTOR on a properly completed and executed State Board of Accounts Form 96 indicates the CONTRACTOR's acceptance of all terms as set out in these specifications and documents and his willingness to complete the project as stated herein and shown on the drawings. 1.2 It is further unden;tood that by the acceptance of, and the proper affixing of the signatures of the OWNER to the Form 96, that a binding contract exists between the OWNER and the CONTRACTOR. 1.3 After the OWNER signs the Form 96, and notifies the CONTRACTOR ofhis acceptance, the CONTRACTOR shall proceed to complete the project with the best workmanship possible conforming to all specifications set out herein and to all details, drawings and notes shown on the plans for this project. S:\Sydney\WPDOCS\01\O'71 S9\divB, wpd B-1 0 1 Prescribed by State Board of Accounts Fonn No. 96 (Revised 2000) /- ." CONTRACTORS BID FOR PUBLIC WORK ..., PART I (To be completed fQr all bids) (Please type or print) Eight Street Emergency Sewer Rehabilitation Morris Street to Short Jackson Street JTL Job No. 07159 Date: January 22, 2008 1. Governmental Unit (Owner): City of Jeffersonville 2. County: Clark 3. Bidder (Firm): Insi tuform Technologies USA, Inc. Address: 17988 Edison Avenue Chy/SUrte: Chesterfield, MO 63005 4. Telephone Number: 5. Agent of Bidder (if applicable): N/A 636-530-8000 Pursuant to notices given, the undersigned offers to fumish labor and/or material necessary to complete ..", the public works project of City of Jeffersonville, Indiana (Governmental Unit) in accordance with plans and specifications prepared by Jacobi, Toombs, and Lanz, Inc. 120 Bell Avenue, Clarksville, IN 47129 and dated January, 2008 for the sum of -,- u.> 0 '^ v- '^-iY.. .,. 4 A.l .{.:;> "" -.r --\--'^ou. ~ c-. '" ..( '3~VQ..,^ "'v-~v- ,,-.,1 se..:"'Q..,^~Y C''''-''- &o\\c.v-<;" C\.PJOD'S~ $ 2...0'-\ I '-=t- T \ . OD The undersigned further agrees to fumish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the Governmental Unit. If the bid is to be awarded on a unit basis, the itemization of the units shall be shown on a separate attachment. The Contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee, or applicant for employment, to be employed in the performance of this contract, with respect to any matter directly or indirectly related to employment because of race, religion. color, sex, national origin or ancestry. Breach of this covenant may be regarded as a material breach of the contract. CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS (If applicable) I, the undersigned bidder or agent as a contractor on a publiC works project. understand my statutory obligation to use steel products made in the United States. I.C. 5-16-8-2. I hereby certify that I and all subcontractors employed by me for this project will use U.S. steel products on this project if awarded. I ~ understand that violations hereunder may result in forfeiture of contractual payments. B-1 02 (; ACCEPTANCE The above bid is accepted this day of . subject to the following conditions: Contracting Authority Members: PART II (Complete sections I, II, III, and IV for all state and local public works projects as required by statutes if project is one hundred thousand dollars ($100,000) or more. (IC 36-1-12-4) Governmental Unit: City of Jeffersonville Bidder (Finn) Insi tuform Technologies USA, Inc. Date: January 22, 2008 r, These statements to be submitted under oath by each bidder with and as a part of his bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. What public works projects has your organization completed for the period of one (1) year prior to the date ofthe current bid? When Contract Amount Class of Work Completed Name and Address of Owner $ 64,714.00 Insituform 2007 South Haven Sewer Works, Valoara $ 74,298.00 Insituform 2007 City of Evansville, IN $705,116.50 Insituform 2007 City of Beech Grove, IN $166,437.50 Insituform 2007 Town of Cicero, IN so, IN 2. What public works projects are now in process of construction by your organization? r', - When to be Contract Amount Class of Work Comcleted Name and Address of Owner $179,630.00 Insituform 2008 Peru Utilities, IN $615,750.00 Insituform 2008 City of South Bend, IN $415,205.00 Insituform 2008 City of Fort Wayne, IN $786,483.00 Insituform 2008 Town of Wolcott, IN 8-103 3. Have you ever failed to complete any work awarded to you? No If so, where and why? ,~~..~ ...., 4. List referenced from private firms for which you have performed work. Proctor & Gamble (816) 241-2891 Abbott Laboratories Wade Osborne (847) 935-5598 Connoco Phillips Clair Budhal (618) 255-2961 Pharmacia & Upjohn Corp. (616) 833-3683 Olin Corp Kelly Rich (618) 258-5495 SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE 1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, completed the project, number of WOrkers, etc. and any other information which you believe would enable the governmental unit to consider your bid.) Perform inspection services and develop SSES report. Set up traffic control and bypass pumping as required, clean and televise pipeline to prepare for installation. If any point repairs are required, notify the Owner or Engineer. Wet-out the Insitutube with resin, set up equipment at site, install the Insitutube and cure. Restore services and~ flow. Clean up site. 2. If you intend to sublet any portion of the work, state the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you expect to require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. '..,....? ~ 'f'-rcv-\6 ~ cQ ~rl o-r --t." C "",^-\v-l\'-.-(:..:\- ~o.-A 3. What equipment do you have available to use for the proposed project? Any equipment to be used by subcontractors may also be required to be listed by the governmental unit. ',Support Truck, Pick-up Truck(s), Reefer Truck, TV Truck, Pumps with Hoses, Compressor(s) Boiler, Jet Truck and/or Vactor 4.:Hav~you' ente~ into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? Otherwise, please explain the rationale used which would corroborate the prices listed: . Yes \till 8-104 r:: SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said fmancial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the governing body awarding the contract must be specific enough In detail so that said governing body can make a proper determination of the bidder's capability for completing the project if awarded. Insituform's Annual Report is attached. SECTION IV OATH AND AFFIRMATION I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct to the best of my knowledge and belief. day of January 2008 Dated at Chesterfield, MO this 22nd Insituform Technologies USA, Inc. . (Nall]ft'Of~on) By ~~ Y;;l)C/ ~ ---- H. Douglas Thomas, Vice President (Title of Person Signing) ACKNOWLEDGEMENT STATE OF MISSOURI ) ) ) COUNTY OF ST. LOUIS H. Douglas Thomas being duly sworn, deposes and says that he is Vice President of the above Insituform Technologies USA, Inc. (Name of Organization) (Title) and that the answers to the questions in the foregoing questionnaires and all statements therein contained are true and correct. Subscribed and sworn to before me this 22nd day of January 2008 ~rI~~.....__ _ JANA LAUSE NotarY PUbIc- NolaIy Seal StateofMfssoUii ",,~isCoun" Commf-r-ecpJrea Oec. 6, 2009 _n # 0S805616 My Commission Expires: 12~05/09 County of Residence: St. Louis 8-105 NON - COLLUSION AFFIDAVIT The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to include anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. He further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale. ...., OATH AND AFFIRMATION I affirm under the penalties of pe~ury that the foregoing facts and information are true and correct to the best of my knowledge and belief. Dated at Chesterfield, MO this 22nd day of January 2008 Insituform Technologies USA, Inc. By //~~) H. Douglas Thomas, Vice President (l1tIe of Person Signing) ...." ACKNOWLEDGEMENT STATE OF COUNTY OF MISSOURI ST. LOUIS ) ) SS: ) H. Douglas Thomas being duly sworn. deposes and says that he is Vice President of the above Insituform Technologies USA, Inc. (Name of Organization) (TItle) and that the statements contained in the foregoing bid, certification and affidavit are true and correct. Subscribed and sworn to before me this 22nd day of January ~~k 2008 Mycommissiol) Expires: . ..12/05/09 '. '-~~'-,-' ~. >~" -:',~ County of Residence: St. Louis JANA LAUSE Notary Public. Notary Seal Slate of M1ssouii at Louis Cou~ My Commission Expires Dee. 5 2009 Commission # 05805615' .., 8-106