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Insituform Technologies USA, LLC
r 11 CHO sn-n £0109 1H9IN213A0 A11210121d VOC 01 Nflf 80.03M 3 o sifra Ali to f TAE , age$50 pping I -a CD CD + m d01V VN MI 9109 0111 aNai III 1111111 111111111111111111111111 II 1111111111111111111111111 1d30 OdII EZ5Z 33tJ (61E) £OLOS VI 001M3REP46Z1VM 33211 S A21�1381fL 911 0-00"f (3.LVM dO AIIO No: W00772236 Date: O1/30/2012 cairlAmag (•)earn 489FLC-430392 INSITUFORM TECHNOLOGIES USA, LLC ACKNOWLEDGEMENT OF DOCUMENT FILED The Secretary of State acknowledges receipt of the following document: Certificate of Authority The document was filed on Jan 25 2012 4:I9PM, to be effective as of Jan 25 2012 4:19PM, The amount of $100,00 was received in full payment of the filing fee, q \ R fsPa;et ev_ ., i iltL� off (tls 4 1At! TARY OF STATE MATT SCHULTZ Secretary of State State of Iowa TO THE SECRETARY OF STATE OF THE STATE OF IOWA: Pursuant to sebtlon 802 of the Iowa Revised Uniform. Limited Liability Company Act the undersigned applies for a certificate of authority to transact business in Iowa and hereby states: LIMITED LIABILITY COMPANY Application for Certificate of Authority 1. The name of the limited liability company; INSITtJFORMTECHNOLOGIES USA, LIE IA. The name the limited liability company will use In Iowa, Jf different than the legal name of the company named'above: ?Refer to note 45 on the baok of this form) 2. The limited liability company 'stormed under the laws of the state (or foreign country) of: Delaware 3. The duration of he llniltedilabilitycompanyis:Pcrpetuat 'L7 4. The street and mailing address ofits registered office In !Owe andlhe name of its registered agent at that rate; p Corporation ServiceCompany NaMe 505 5th:Avenue, Suito 729, Des Moines, IA 50309 Address City. Stale Zip The registered office and registered agent comply with the requirements of section A89.113 The address of the office required to be maintained In the stato of its formation bythe law ofthat State (if such an address is not required,.the address of the principal office of the limited liability company): 17888 Edison Ave. Address Chesterfield, MO 63005 J 1— tt City Slate Zip 6.(A) This foreign limited liability company Is governed by an operating agreement that establishes or provides for the establIshmentof designated series of transferable interests having separate rights, powers, of duties with respect to speeitedproperty or obligations Of the foreign limited liability company; or profits and losses associated with the specified property or obligations. ❑ YES ® NO (B).AII debts, liabilities, and obligations incurred, contracted for, or otherwise existing With respect to a'particular Series, if any, are enforceable against the assets of suoh se, les only, and not against the assets of theforeign limited liability company 0 YES 0 NO 7. The effective date and thne of this application, if differentthan the date and time of filing: (Roforto note 114 on the beak of this form) Date Time 8. A certificate of existence or a record of similar import, signed by the secretary of state of other official having custody of the company's publicly flied report In the state or other Jurisdiction under whose law the company is formed,:accom• patties this application, Signature Type or print namo and title David P. Morris, Mannger 035 gala 7109 Date Jnnuary 9 ,2012 !De taware 'The .first State PAGE 1 I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF DELAWARE, DO HEREBY CERTIFY "INSITUFORM TECHNOLOGIES USA, LLC" IS DULY FORMED UNDER THE LAWS OF THE STATE OF DELAWARE AND IS IN GOOD STANDING AND HAS A LEGAL EXISTENCE SO FAR AS THE RECORDS OF THIS OFFICE SHOW, AS OF THE EIGHTEENTH DAY OF JANUARY, A.D. 2012. AND I DO HEREBY FURTHER CERTIFY THAT THE SAID "INSITUFORM TECHNOLOGIES USA, LLC" WAS FORMED ON THE TWENTY-SECOND DAY OF DECEMBER, A.D. 1983. AND I DO HEREBY FURTHER CERTIFY THAT THE ANNUAL TAXES HAVE BEEN PAID TO DATE. 2024080 8300 120059761 You may verify this certificate online at oorp.delavare.gov/authvor.shtml FILED IOWA SECRETARY OF STATE 9/ 7' W772236 Jeffrey W Bullock SecretaryofState AUTHEN TION: 9304231 DATE: 01-18-12 Insituform A,L.0 17988 Edison Avenue • Chesterfield Missouri 63005 CITY CLERK/CITY HALL CITY OF WATERLOO 715 MULBERRY STREET WATERLOO, IA 50703 BID BOND ENCLOSED PROPOSAL FOR FY 2023 CIP PIPELINING PHASE iVA3 CITY CONTRACT NO. 1063 ADDENDA: BID DATE: JUNE 9, 2022 @ 1:00 P.M. IM MB Win ,awes.. aweam+. m• xnm=xv Ili WWIe, MEM 1”5®�® firMEIMIIIIII Waterloo Pal ® 11...1.1 ----- DanielsMe :.mm .ecr ®o .jeR commercial- es antral censtructlen em ffsns3 m3IIIIIIII . 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Poured Concrete wundatlen end Structure Cm -enters, Sevetwal Steel and Precast Concrete Masonry Centranow Me' lldIns Exterior Centractets,Orywall and on Contractors, Finish pentry Contractors. Other Building AnisWn6 Contractors,traAors, All ,MA..a.eEmra rir a, 01 sloe Sweet Kinser 3,e„_,. e,m..,.e. Ifkik �,ri,.mE3o ria veireR� e M EE, r3r3==■ HCirldge pckea Curb and Gutter. entePleVer e Sidewalks,riterkw aMaWe ucasian �� Inc. Wu. pet®,;,trio,¢®°� H®HHa.��m PP:IL/PULP sn+au3s _avopreparationtlJr Prepare -Ow !cline ated CIA e�aa.��M%mwawaM.rrieorizontal Wring and Censtructeracter tl®oem.a. ... MMeiand �,uw, -,u.- 3s Sit Collection w eAt1 ■ .... -r�-sEs-,.:. ®� =n+rsu3u- ,etWeCcre,=m..e.aw.siceai.=,ay.Mia.Ilaogk.coe at. e,ewmple&Crash a,mmeCulvert Control W:eed, eu and Rio-epL Enevalanirand Shrubs), cing. Plowable Marta,. Gee Grid, Guardrail, pavement eceWe, �vis�Pavement emeiewEaR.Rw WOW Paving �pfansho�uld,r Pace,asmmse.ennn.e„ Whdralw, Traffic emenaaaregay. ,weer/Suppben Ep aawVackRaivrorc ngSteei,um.an. m.IWOOeas�ea CoweS,Reinforce.EpowStreet, ReinforcnwBl,ckStee, ADA Pat. Eabr:rc0We Products; olwate;` Recyclable Materials Methane Products Merchant Whelaalee Plastic cave, Forms/Shapes Me,aevrw,cer,.,.seexersem„u<eov Ma,ecai,Mereevr v Seaaie,. MetlSrv.eCenters and oeer M!l merhav,wAmeselem WOE occariav MMsca,.,Ree.rand :e. . mr, Ameoumaa 3194461M1 a mr3,esrreet Sll0$ m,v.3v.,«,M,.,.er.„e1313<„m _r2on Sum weE MBE Caucasian — ... L nates.Ruiewaert 320-W3200 P..o.nxfl 1• mM,.<,wer<,e.mail.ter 5 „urx 5/31/2022 ��u�rmmm�n. .m.....c..�wv M..u.A.�............, H IA H� . Water Supply & sterns; Water Peals consfructlow0L1 line a ww ing Derwe Canst rate',esp'm e&n3eeptaUsed s�oocelsi Mobile ,u ,.a eiaW �ss Middletown 21.,:3■ „3r,e° HH rmareteDewin.Whart patching -Crack aadlnxeal smb0ell rermswier �H ere Revin.,LLC IIHH e� ®eru rota Remand Hydre-twaratlen:n.e,mewr6.R.meya� sewer/Water eg'w: `"e::: Insituforme An Aegion r Company CORPORATE BACKGROUND Insituform Technologies, LLC is a diversified, international corporation specializing in trenchless reconstruction of municipal and Industrial pipelines of all types - sewer, storm drain, water, gas oll, chemical process, slurry and nuclear power pipelines. Application sizes range from under 6-inches to 120-inches in diameter. Based on size, experience, technology, capability and resources, INSITUFORM is the worldwide leader in full -spectrum piping reconstruction contracting. Insituform's expertise is based on over 50 years of experience spent in the manufacturing and installation/reconstruction of more than 25,000 miles (over 132,000,000 ft.) of pipe. Currently, INSITUFORM offers a full spectrum of trenchless rehabilitation products including Insituform's flagship gravity cured -in -place pipe (CIPP), iPlus Infusion®, iPlus tnfusion® UV felt, iPlus®Composite, Tite Liner® HDPE systems for industrial/pressure pipelines and our InsituMaln® and Thermopipe® Systems for sanitary sewer force mains, transmission and distribution mains, alongside our robotic service reinstatement technologies. The corporate history that encompasses today's worldwide Insituform Technologies, LLC organization derives from a host of resources, people, technology and experience merged from former licensees and affiliates of the original Insituform® pipe reconstruction process. INSITUFORM is a leader in quality management, becoming the first specialty piping corporation to receive ISO 9000 quality installation certification in 1995. As a vertically integrated company, we hold ISO 9000 certifications in materials manufacturing, resign impregnation/wetout, and field installation and control every step of the process, from start to finish. Insituform Technologies is one of the largest trenchless technology companies in the world, with annual revenues exceeding $914 million in 2010. PERSONNEL Insituform Technologies, LLC's worldwide organization consists of over 3,000 employees. Every specialty and function associated with an International, technology -driven business is incorporated. Outside of manufacturing operations, the predominance of INSITUFORM personnel engage in project crew duties for pipeline reconstruction. INSITUFORM maintains and staffs an extensive Research and Development facility engaged in new product and technical installation development. Experts are available to assist operations units in developing specialized solutions to particular client needs for underground piping system analysis and reconstruction. INSITUFORM maintains a centralized design team at the world headquarters in St. Louis, Missouri with responsibility for ensuring that service conditions are met by products in each application. When necessary, special industrial design considerations and constraints such as corrosion, abrasion, unusual loading, pressure, temperature, etc. are fully included In specific application designs. INSITUFORM has assigned technical market managers to specific segments who have intimate knowledge of process and facility operations and are able to provide advice and field technical assistance in special applications as may be required to meet critical or unusual client needs. By nature, field applications of pipeline service, assessment and reconstruction activities are highly regionalized. In the United States, INSITUFORM meets the needs of local municipal, industrial and military clients for responsive service by deploying personnel at strategic locations to minimize the cost and burden to clients of extensive mobilization. As an Integrated company, sharing of expert personnel and specialized equipment between locations in response to client and project needs is part of normal operations. Briefly, here are Just a few of the benefits realized from the reconstruction of pipelines using the Insituform® cured -in -place pipe (CIPP) process: Virtually eliminates excavation problems - Depending on the type of pipe or passageway to be reconstructed (sewers, drains, or conduits), excavation can virtually be eliminated. Existing access (sewer manholes) is usually sufficient. Side connections can generally be 'reinstated by cutting out from within. Bends can be negotiated. Restores full size capacity, reduces maintenance - These tight -fitting pipes are continuous over pipe Joints, openings and faults, and the capacity is nearly always increased. The smoothness also reduces deposits because there are no places for deposits to form, thereby reducing maintenance. Builds corrosion -resistant pipe, resists chemical attack - In the case of the Insituform process, various thermosetting resins can be selected to resist the corrosive effects of the effluent. Builds a continuous pipe - (a new pipe within the old) - Insituform® CIPP bridges breaks and missing sections of pipe eliminating infiltration, exfiltration or loss of product in pressure pipes. Insituform fits tightly and bridges disconnected pipes into a single continuous pipe. Reconstructs unusually shaped pipes without loss of capacity - Elliptical, egg -shaped, flat bottom horseshoe or rectangular conduits can be reinstated to their existing shape by the tight fitting Insituform process. Accomplishes these things in sizes from 6- to 120-inches in diameter — Insituform®CIPP has been constructed in these sizes and may be applicable to those beyond Solves difficult lobs - In addition to negotiating bends, it is possible to reconstruct remote sections inaccessible to wheeled vehicles (e.g. inside building) with the Insituform process. In addition to being installed without excavation, Insituform® CIPP has been installed where access to only one end is feasible (vertical wells). Also, It Is possible to reconstruct pipelines with reducers or only a portion of a pipeline. Solves stringent time restraints - Preparation time is reduced by eliminating street openings and risk of damage to other utilities. Insituform® CIPP can generally be installed and completed in less on-the-job time than traditional open cut construction methods. Offers more convenience to commerce and public - Little inconvenience is caused to the public, commercial business or existing utility operations because excavations are generally eliminated. Little work space is needed for installation. This alone means fewer restrictions on access to property and shops and greater assurance of safety. Longevity - For normal applications, such as gravity sewers, the service life of Insituform® CIPP can be expected to approach fifty years. Service life of Insituform CIPP is a function of the temperature, pressure, velocity, and chemical and abrasive properties of the materials being carried. Custom -Engineered — Insituform® tubes are custom -engineered to optimize total life performance using time -proven formulas. These take into account requirements for diameter, length, condition of pipe, flow rates, temperature, pressure and corrosiveness of the materials being carried. INSITUFORM, STANDARD INSTALLATION PROCESS The standard Insituform® process has been used throughout the world for the rehabilitation of over 25,000 miles, of pipe ranging in size from 6" to 120". The process uses a resin -impregnated, flexible felt tube which is installed into and through an existing pipe using water or air pressure. While the liner is held tightly against the host pipe, hot water, steam or Ultra -violet (UV) light is utilized to cure the thermosetting, or light -cured resin. The flexible resin tube can accommodate various pipe shapes — round, square, rectangular, oval or arched. The Insituform® tube can negotiate bends, elbows, missing sections, offset joints, misalignment and steep slopes. Standard applications include process and sanitary sewer, storm drains, process lines, slurry lines, force mains and siphons. Resin systems used include polyester, vinyl ester and epoxy, designed to meet service requirements. Installation lengths typically range from 250 feet to over 2,500 feet, depending on pipe size and condition. Service laterals are re -opened internally using robotic cutters. 3 FORM OF BID OR PROPOSAL FY 2023 CIP PIPELINING PHASE IVA3 CONTRACT NO. 1063 CITY OF WATERLOO, IOWA Honorable Mayor and City Council Waterloo, Iowa Gentlemen: Limited Liability Company 1. The undersigned, being a corporation -existing under the laws of the State of Delaware , a Partnership consisting of the following partners: n/a having familiarized (himself) (themselves) (itself) with the existing conditions on the project area affecting the cost of the work, and with all the contract documents listed in the Table of Contents and Addenda (if any), as prepared by AECOM now on file in the office of the City Clerk, City Hall, Waterloo, Iowa, hereby proposes to furnish all supervision, technical personnel, labor, materials, machinery, tools, appurtenances, equipment, and services, including utility and transportation services required to construct and complete this FY 2023 CIP PIPELINING PHASE IVA3, CITY CONTRACT NO. 1063, all in accordance with the above -listed documents and for the unit prices for work In place for the following Items and quantities: FY 2023 CIP PIPELINING PHASE IVA3 CITY OF WATERLOO, IOWA CITY CONTRACT NO. 1063 Item Description Unit Estimated Quantiles Unit Price Total Amount SASE B BID >' 1 8' Diameter CIP Pipe Lining LF 16,824.0 $ 30 .10 $ 508' O N, t, 2 10" Diameter CIP Pipe Lining LF 5,084.0 $ 3 (9.,3U $ j kLj. i L% 9, 20 3 12" Diameter CIP Pipe Lining LF 1,735.0 $ L,J) iYO $ 1) )' + O0 4 Lateral Reinstatement EA 333.0 $ / ? 0,00 $ 3 1 fq tp to , 00 5 3-FT Lateral Grouting EA 333.0 $ 38 ^AO $)2ii 5o3;1 6 Pipe Televising - 8" LF 33,648.0 $ (, 3 b $ qd i cJ I ,,t.4--D 7 Pipe Televising - 10" LF 10,168.0 $ j ,,3D $ i,'S' r,? I Y,t/(� 8 Pipe Televising - 12" LF 3,470.0 $ ! , j 6 $ -j' 0 c-, , '0 9 Type A Pipe Cleaning - 8" LF 16,824.0 $ ;i , i 0 $ 35, 3 3 D ,LJC) 10 Type A Pipe Cleaning - 10" LF 5,084,° $ 2 , 6 Q $ 10 d to j c1O 11 Type A Pipe Cleaning - 12" LF 1,735.0 $ 2 ,30 $ , qqD , 51) 12 Type C Root Removal - 8"-10" LF 10,954.0 $ , J t> $ t } ) 6j,5, L,210 13 Type C Root Removal-12"-15" LF 867.0 $ , j 0 $ 3e (p, 70 14 Type D Lumberjack - 8"-10" LF 10,954.0 $ , / i5 $ i U q J Llb 15 Type D Lumberjack - 12" -15" LF 867.0 $ ) (j $ rib 7t) 16 Protruding Taps Removal EA 50.0 $ 3 q b £ DO $) 9 TOTAL BASE BID $ J , () io i 2,LaD v ()it) FORM OF BID AECOM 60682318 CONTRACT NO. 1063 Page BF-1 OF 3 FY 2023 CIP Pipelining Ph IVA3 Item Description LTERNATE NO;`1 SA NO. 19 101 J 36" Patching or Grouting Unit LS Estimated Quantiles 1.0 BID ALTERNATE NO. 1 TOTAL PROJECT TOTAL Unit Price ` OO rea Total Amount >) $ 13)5000D& 2. It is understood that the quantities set forth are approximate only and subject to variation and that the unit, bid price for the work done shall govern in the actual payment to Contractor. The Contract shall be awarded based on the TOTAL BASE BID. 3. In submitting this bid, the bidder understands that the right is reserved by the City of Waterloo, Iowa, to reject any or all bids. If written notice of the acceptance of this bid is mailed, telegraphed, or delivered to the undersigned within thirty (30) days after the opening thereof, or at any time thereafter before this bid is withdrawn, the undersigned agrees to execute and deliver an agreement in the prescribed form and furnish the required bond and certificate of the insurance within ten (10) days after the agreement is presented to him for signature, and start work within ten (10) days after "Notice to Proceed" Is issued. Security in the sum of Five percent of amount bid and zero dollars Dollars ($ 5% and 00/100 ) in the form of a bid bond is submitted herewith in accordance with the INSTRUCTIONS TO BIDDERS. 5. Attached hereto is a Non -Collusion Affidavit of Prime Contractor. 6. Attached hereto is the Bidder Status Form indicating Resident Bidder Certification ( ), or Non -Resident Bidder Certification ( X ). (Mark one.) 7. The bidder is prepared to submit a financial and experience statement upon request. The Prime Contractor and Subcontractor(s), which have performed an aggregate of $10,000.00 in work for the City in the current calendar year, are prepared to submit an AAP or Update and an EOC, within ten (10) days of notification that the bid submitted is lowest and acceptable, The bidder has received the following Addendum or Addenda: Addendum No. Date It 1 at-' ✓L(A r./tea, 10. The bidder shall list the MBENVBE subcontractor(s), amount of subcontracts and bid items on the City of Waterloo Minority and/or Women Business Pre -bid Contact Information Form submitted with this Form of Bid or Proposal. The apparent low Bidder shall submit a list of all other Subcontractor(s) to be used on this Project to the City of Waterloo by 5:00 p.m. the business day following the day Blds on this Project are due along with the Non -Collusion Affidavits of All Subcontractor(s). The Contractor shall submit information on subcontractors on "SUBCONTRACTOR REQUEST AND APPROVAL" Form to be provided by City prior to approval of contract. The subcontractors listed on this proposal and/or submitted to the Contract Compliance Officer cannot be changed except for the following reasons: FORM OF BID CONTRACT NO. 1063 Page BF-2 OF 3 AECOM 60682318 FY 2023 CIP Pipelining Ph IVA3 1) The City of Waterloo does not approve the subcontractors. 2) The subcontractors submit in writing that they cannot fulfill their subcontracts. 11. The bidder has filled in all blanks on this proposal. Those blanks not applicable are marked "none" or "NA". 12. The bidder has attached all applicable forms. 13. The Owner reserves the right to select alternates, delete line items, and/or to reduce quantities prior to the award of a contract due to budgetary limitations. Insituform Technologies USA, LLC June 9, 2022 BY: (Name of Bidder) (Date) Title Jana Lause, Contracting & Attesting Officer Official Address: (Including Zip Code): 5R0 Goddard Avenue Chesterfield, MO 63005 I.R.S. No. 43-1319597 FORM OF BID CONTRACT NO, 1063 Page BF-3 OF 3 AECOM 60682318 FY 2023 CIP Pipelining Ph IVA3 My commission expires July 8, 2024 NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of Micsrtnri )ss County of st. 1 outs Jana Lause being first duly sworn, deposes and says that: Contracting & Attesting Officer 1. He is (Owner, Partner, Officer, Representative, or Agent) of Insituform Technologies USA, LLC the Bidder that has submitted the attached Bid; He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid Is genuine and is not a collusive or sham Bid; 4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees, or parties in interest, including this affiant, has In any way colluded, conspired, connived or agreed, directly or indirectly, with any other Bidder, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other Bidder, or, to fix any overhead, profit or cost element of the bid price or the bid price of any other Bidder, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against the City of Waterloo, Iowa, or any person interested in the Proposed Contract; and 5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in interest, including this affiant. (Signed) r�C /�2f r,, gyp_ Jana Lause, Contracting & Attesting Officer Title Subscribed and sworn to before me this 9th day of June 20 22 fi ,IY A.2(i IC Diane Partridge, Notary Public UIANE P'ANiklllbGt Title Pub&c • Notary Seal STATE OF MISSOURI St. Louis Cqunty My Commresion kxpxes: July 8, 2024 Commission # 12595471 NON -COLLUSION AFFIDAVITS CONTRACT NO.1063 Page NCA-1 OF 2 AECOM 60682315 FY 2023 CIP Pipelining Ph IVA3 Bidder Status Form To be completed by all bidders Part A Please answer "Yes" or "No" for each of the following: [l Yes ■ No My company is authorized to transact business in Iowa. (To help you determine if your company is authorized, please review the worksheet on the next page). ❑ Yes • No My company has an office to transact business in Iowa. • Yes M No nYes ❑ No ❑ Yes cc-j No My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail, My company has been conducting business in Iowa for at least 3 years prior to the first request for bids on this project. My company is not a subsidiary of another business entity or my company is a subsidiary of another business entity that would qualify as a resident bidder in Iowa. If you answered "Yes" for each question above, your company qualifies as a resident bidder. Please complete Parts B and D of this form. If you answered "No" to one or more questions above, your company is a nonresident bidder. Please complete Parts C and D of this form. To be completed by resident bidders N/A Part B My company has maintained offices in Iowa during the past 3 years at the following addresses: Dates: / / to / / Address: City, State Zip: Dates: / / to / / Address. City, State, Zip: Dates: / / to / / Address: You may attach additional sheet(s) if needed. City, State, Zip: To be completed by non-resident bidders Part C 1. Name of home state or foreign country reported to the lowa Secretary of State: Missouri 2. Does your company's home state or foreign country offer preferences to resident bidders, resident labor X force preferences or any other type of preference to bidders or laborers? 3. If you answered "Yes" to question 2, identify each preference offered by your company's home state or foreign country and the appropriate legal citation. See Attached Yes I I No You may attach additional sheet(s) if needed. To be completed by all bidders Part D I certify that the statements made on this document are true and complete to the best of my knowledge and I know that my failure to provide accurate and truthful information may be a reason to reject my bid. Firm Name: Insituform Technologies USA, LLC Signature: ,/a A ,;AA Date: June 9, 2022 Jana' 'Lause, Contacting & Attesting Officer You must submit the completed form to the governmental body requesting bids per 875 Iowa Administrative Code Chapter 156. This form has been approved by the Iowa Labor Commissioner. 309-6001 (09-15) BSF-I Worksheet: Authorization to Transact Business This worksheet may be used to help complete Part A of the Resident Bidder Status form. If at least one of the following describes your business, you are authorized to transact business in Iowa. ® Yes ■ No My business is currently registered as a contractor with the Iowa Division of Labor. Yes ® No My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes. Yes ® No ❑ Yes ] No ❑ Yes I(] No ■ My business is a general partnership or joint venture. More than 50 percent of the general partners or joint venture parties are residents of Iowa for Iowa income tax purposes. My business is an active corporation with the Iowa Secretary of State and has paid all fees required by the Secretary of State, has filed its most recent biennial report, and has not filed articles of dissolution. My business is a corporation whose articles of incorporation are filed in a state other than Iowa, the corporation has received a certificate of authority from the Iowa secretary of state, has filed its most recent biennial report with the secretary of state, and has neither received a certificate of withdrawal from the secretary of state nor had its authority revoked. Yes El No My business is a limited liability partnership which has filed a statement of qualification in this state and the statement has not been canceled. ❑ Yes :d No My business is a limited liability partnership which has filed a statement of qualification in a state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of cancellation has not been filed. ■ Yes EZI No My business is a limited partnership or limited liability limited partnership which has filed a certificate of limited partnership in this state, and has not filed a statement of termination. Yes ® No My business is a limited partnership or a limited liability limited partnership whose certificate of limited partnership is filed in a state other than Iowa, the limited partnership or limited liability limited partnership has received notification from the Iowa secretary of state that the application for certificate of authority has been approved and no notice of cancellation has been filed by the limited partnership or the limited liability limited partnership. ❑ Yes k] No My business is a limited liability company whose certificate of organization is filed in Iowa and has not filed a statement of termination. E Yes ❑ No My business is a limited liability company whose certificate of organization is filed in a state other than Iowa, has received a certificate of authority to transact business in Iowa and the certificate has not been revoked or canceled. 309-6001 (09-15) BSF-2 Preference Yes Contracts for Job or Service Performance Veterans Preference for the Blind Scope of Preference & Conditions Statute 34.070 -- Reciprocal law applies to all commodities and tangible personal property manufactured, mined, produced, processed, or grown within the State of Missouri, to all new generation processing entities defined in Section 3481432, RSMo, except new generation processing entities that own or operate a renewable fuel production facility or that produce renewable fuel, and to companies doing business as Missouri firms, corporations or individuals, when quality is equal or better and delivered price is the same or less. Such preference may be given whenever competing bids, in their entirety, are comparable. "Commodities' shall include any agricultural product that has been processed or otherwise had value added to it in this state. The preference is not applied to public works or product transportation where bid is less than $5,000.00, nor is it applied for bids with Department of Transportation when Federal funds are involved. Vendor need not claim preference. Statute 34.073.1 -- In awarding contracts for the performance of any job or services, preference shall be given to companies doing business as Missouri firms, corporations or individuals or which maintain Missouri offices or places of business when the quality of performance promised is equal or better and the price quoted is same or less, or whenever competing bids, in their entirety, are comparable. In awarding contracts for the performance of any job or service, all agencies, departments, institutions, and other entities of this state and of each political subdivision of this state shall give a three point bonus preference to service -disabled veteran businesses. The goal is not required and the provisions of this subsection shall not apply if there are no (or insufficient) bids or proposals submitted to the public entities listed above. Statute 34.165 — When making purchases for the State, its governmental agencies or political subdivisions, the commissioner of administration shall give bidding preference consisting of a ten point bonus on bids for products and services manufactured, produced or assembled in qualified nonprofit organizations for the blind. BID BOND KNOW ALL MEN BY THESE PRESENTS, that we Insituform Technologies USA, LLC as Principal, and Travelers Casualty and Surety Company of America as Surety are held and firmly bound unto the CITY OF WATERLOO Iowa, hereinafter called "OWNER." In the penal sum Five Percent of the Amount Bid Dollars ($ 5% Amount Bid ) lawful money of the United States, far the payment of which sum will and truly be made, we bind ourselves our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. The condition of this obligation is such that whereas the Principal has submitted the accompanying bid dated the 9 day of June , 20 22 , for FY 2022 CIP Pipelining Phase IVA 3, City Contract No. 1063 NOW, THEREFORE, (a) If said Bid shall be rejected, or in the alternate, (b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the form specified and shall furnish a bond for his faithful performance of said contract, and for the payment of all persons performing labor or furnishing materials in connection therewith, and shall in all other respects perform the agreement created by the acceptance of said Bid, Then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated. By virtue of statutory authority, the full amount of this bid bond shall be forfeited to the Owner in liquidation of damages sustained in the event that the Principal fails to execute the contract and provide the bond as provided In the specifications or by law. The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its bond shall be in no way impaired or affected by any extension of the time within which the Owner may accept such Bid or execute such contract; and said Surety does hereby waive notice of any such extension. IN WITNESS WHEREOF, the Principal and the Surety, have hereunto set their hands and seals, and such of them as are corporations, have caused their corporate seals to be hereto affixed and these pres- ents to be signed by their proper officers this 9 day of June A.D. 20_22 lnsitufonn Technologies USA, LLC 580 Goddard Avenue, Chesterfield, MO 63005 Principal Witness Diane Partri e Contracting & Attesting Officer Witness Ashley Miller, Witness BID BOND AECOM 60682318 tl By C. , (Seal) (Title) Jana Lause, Contracting & Attesting Officer Travelers Casualty and Surety Company of America One Tower Square, Hartford, CT 06183 (Seal) Surety By Andrew P. Thanap, tforrt€y-1n-fact CONTRACT NO. 1063 Page BB-1 OF 1 FY 2023 CIP Pipelining Ph WAS State of Missouri County of St. Louis On 6/9/2022 before, me, a Notary Public in and for said County and State, residing therein, duly commissioned and sworn, personally appeared Andrew P. Thome known to me to be Attorney -in - Fact of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA the corporation described in and that executed the within and foregoing instrument, and known to me to be the person who executed the said instrument in behalf of said corporation, and he duly acknowledged to me that such corporation executed the same. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal, the day and year stated in this certificate above. Ashleyi ta \ Mer`I otary Public ASHLEY MILLER NOTARY PUBLIC - NOTARY SEAL STATE OF MISSOURI COMMISSIONED FOR ST. LOUIS COUNTY MY COMMISSION EXPIRES DEC. 21, 2025 ID #13556557 My Commission Expires: TRAVELERS J Travelers Casualty and Surety Company of America Travelers Casualty and Surety Company St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint ANDREW P THOME of CHESTERFIELD , Missouri , their true and lawful Attorney(s)-In-Fact to sign, execute seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory In the nature thereof on behalf of the Companies In their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 21st day of April, 2021. State of Connecticut By: City of Hartford ss. Robert L. Rane1E'Senior Vice President On this the 21st day of April, 2021, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of each of the Companies, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of said Companies by himself as a duly authorized officer. IN WITNESS WHEREOF, I hereunto set my hand and official seal. My Commission expires the 30th day of June, 2026 Anna P. Nowik, Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of each of the Companies, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and Agents to ad for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory In the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chal man, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed In the office of the Secretary; and It is FURTHER RESOLVED, that any bond, recognizance, cont act of indemnity, or writing obligatory In the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (6) duly executed (under seal, if required) by one or more Attorneys -in -Fact and Agents pursuant to the power prescribed In his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it Is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in - Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory In the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which It Is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary of each of the Companies, do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which remains In full force and effect. Dated this 9 day of June 2022 . Kevin E. Hughes, Assistant Secretary To verify the authenticity of this Power of Attorney, please cal/ us at 1-800-421-3880. Please refer to the above -named Attorneys) -in -Fact and the details of the bond to which this Power of Attorney is attached. 2 cc UNI O a Z 0-O z2 W u)O W z ZF =U CO 1— W Z DI O U 0 la mm W cc a N O c Prime Contractor Name: Insituform Technologies USA, LLC Title: Jana Lause, Contracting & Attesting OfficeDate: N 0 a N 0 •C .0 p ro O U r ¢ o O N O O 0 a 0 mE N • 0 O 0 O a N N yw N ro a fl U w o a 2W O m 3 o0 � • ro • c W o m 2 CO W 5m c rom 0)2 O c co Et Li= 0 • Z t S co a � N � t Gi3(\�a O a U m 2 w Z • c) O ro m 3 m U o O) o 0 m y m a) a)c W N N N N G N m W v CO CO 0 • m • E T 0 m o .c C • ci o • Y y c o •5 c o O p ▪ W EE° c c C o U N c CO0oma c L O a+ 3 o g ro Y Z > o c c a0 N a)t N :p O � a m a E c o r a U E a ° E C o 0 :c a I-m O L U) m 0 '2 N 0'� N o v ca 0 L. 0 0 t, >, O O' • o 2 a a7 O v N o N p • ro YE_.115+ E O co 4- U c U le N 3 o co m N N r N E 0 o N E o c 4- cu D ro o0 o O a)E n▪ 0 w 3 0 O a) • 42 c N N m m 0 W y ma O a ro o ro wy .c c 'O O C Eo O .c O 3 -o 0 N ro a)• O 0 N C • E w c •0 0 m ILI Co av rna W• Z DO mu) za O 1— co W O W • m OLL W Z LL O m J2 m !mites Received Quotation used in bid Dollar Amount Proposed to be Subcontracted O iy Dates Contacted f�} Yes/No 0 'fl y u la' 45 Ca Ugl 1VIBE/WBE Subcontractors (Forrn CCO-4) Rev. 06-20-02 0 co o ' a we E a co CONTRACT NO. 1063 w co co m zN ON a0 U. co O 2 co 0 2U Fw Attachment 1 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid) U.S. Environmental Protection Agency Certification of Non -Segregated Facilities (Applicable to contracts, subcontracts, and agreements with applicants who are themselves performing federally assisted construction contracts, exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause.) By the submission of this bid, the bidder, offeror, applicant, or subcontractor certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. He certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he will not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The bidder, offeror, applicant, or subcontractor agrees that a breach of this certification is a violation of the Equal Opportunity clause in this contract, As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national original, because of habit, local custom, or otherwise. He further agrees that (except where he has obtained identical certifications from proposed subcontractors for specific time periods) he will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause; that he will retain such certifications in his files; and that he will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NON -SEGREGATED FACILITIES A Certification of Non -segregated Facilities, as required by the May 9, 1967, order (33 F.R. 7808, May 28, 1968) on Elimination of Segregated Facilities, by the Secretary of Labor, must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Opportunity clause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually). , 1 ( { .2u&e, June 9, 2022 Signature Date Jana Lause, Contracting & Attesting Officer Name and Title of Signer (Please Type) NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001. EPA-7 5720-4.2 SRF-2 January 2021 Attachment 2 SRF Required Front -End Specifications (This form must be completed and signed by the Prime Contractor and submitted with the bid) Debarments and Suspensions Any bidder or equipment supplier whose firm or affiliate is listed in on the U.S. General Services Administration Excluded Parties List will be prohibited from the bidding process. The excluded parties records search engine is located at the System for Award Management (SAM) website: https://www.sam.gov/SAM/. Pursuant to 2 CFR Part 180, as supplemented by 2 CFR 1532, any entity submitting a bid while the SAM website lists that entity as having an active exclusion will be determined by the DNR to be a non -responsive bidder and will not be able to receive SRF funding. United States Environmental Protection Agency Washington, DC 20460 Certification Regarding Debarment, Suspension, and Other Responsibility Matters The prospective participant certifies to the best of its knowledge and belief that it and the principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction: violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification; and (d) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, or local) terminated for cause or default. I understand that a false statement on this certification may be grounds for rejection of this proposal or termination of the award. In addition, under 18 U SC Sec. 10 01, a false statement may result in a fine of up to $10,000 or imprisonment for up to 5 years, or both. Jana Lause, Contracting & Attesting Officer Typed Npme & Title of Authorized Representative 1') June 9, 2022 Signaturd of Authorized Representative Date ❑ I am unable to certify to the above statements. My explanation is attached. SRF-3 January 2021 Attachment 3 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid) Disadvantaged Business Enterprise (DBE) Solicitation It is EPA's policy that recipients of EPA financial assistance through the State Revolving Fund programs award a "fair share" of subagreements to small, minority and women -owned businesses, collectively know as Disadvantaged Business Enterprises (DBEs). Iowa's Fair Share goals are: Minority -Owned Business Enterprise (MBE) Goal Women -Owned Business Enterprise (WBE) Goal Construction 1.7% 2.2% Supplies 0.6% 5.6% Services 2.5% 11.3% Goods/Equipment 2.5% 10.4% Average 1.8% 7.4% Only work performed by certified DBEs can be counted toward the goals. In Iowa, DBEs must be certified through the Iowa Department of Transportation (IDOT). Information on certification requirements and a list of certified DBEs is on the IDOT website at https://secure. iowadot.gov/DBE/Home/Index/. Prime contractors' DBE requirements for SRF projects include: • Taking affirmative steps for DBE participation • Documenting the efforts and the proposed utilization of certified DBEs PR ---------- SRF Applicant: City of Waterloo, Iowa Bidder: Insituform USa, LLC Technologies Address: 580 Goddard Avenue, Chesterfield, MO 63005 Contact Person: Jana Louse, Contacting & Attesting Officer Signature: ( 1 l r 7tc1 to e;..i aR Phone Number: 636-530-8000 E-Mail Address: jlause@aegion.com Check if Prime Contractor is: Minority -Owned Women -Owned ❑ SRF-4 January 2021 GOOD FAITH EFFORTS CHECKLIST Please complete the checklist to determine if you have complied with the requirement to make good faith efforts to ensure that certified DBEs have the opportunity to compete for procurements funded by EPA financial assistance funds. Bidders/offerors must make good faith efforts prior to submission of bids/proposals. 1. Did you ensure that DBEs are made aware of contracting opportunities to the fullest extent practicable through outreach and recruitment activities? d Yes 1 No 2. Did you make information on forthcoming opportunities available to DBEs and arrange time frames for contracts and establish delivery schedules, where the requirements permit, in a way that encourages and facilitates participation by DBEs in the competitive process? This includes, whenever possible, posting solicitation for bids or proposals for a minimum of 30 calendar days before the bid or proposal closing date. ❑ Yes ❑ No 3. Did you consider in the contracting process whether firms compet ng for large contracts could subcontract with DBEs? This will include dividing total requi ements, when economically feasible, into smaller tasks or quantities to permit maximum participatpn by DBEs in the competitive process. Q Yes ❑ No 4. Did you encourage contracting with a consortium of DBEs when antract is too large for one of these firms to handle individually? Yes U No 5. Did you use the services of the Small Business Administration and the Minority Business Development Agency of the Department of Commerce to identify potential subcontractors? Yes ❑ No 6. List the potential DBE subcontractors that were contacted. Only list those that are certified through the Iowa Department of Transportation. Name How Contacted (e.g. letter, phone call, fax, e-mail) Response not interested, (e.g. did not respond, not competitive) (Y) 1-1 a t 9 CIOC� m e -(-7 ' PROPOSED UTILIZATION OF DBE SUBCONTRACTORS Please include Attachments 4 and 5 to document the proposed utilization of certified DBE subcontractors. SRF-5 January 2021 CONTRACT ADMINISTRATION PROVISIONS Several contract provisions are required to prevent unfair practices that adversely affect DBEs. These include: 1. Prime Contractor must pay its Subcontractor for satisfactory performance no more than 30 days from the Prime Contractor's receipt of payment from the SRF loan recipient. 2. Prime Contractor must notify the SRF loan recipient in writing prior to termination of a DBE subcontractor for convenience. 3. Prime Contractor must employ the six Good Faith Efforts to solicit a replacement subcontractor if a DBE subcontractor fails to complete work under a subcontract for any reason. SRF-6 January 2021 Attachment 4 SRF Required Front -End Specifications (This form must be completed and signed by Prime and DBE Subcontractor for each subcontract and submitted with the bid) Disadvantaged Business Enterprise Program DBE Subcontractor Performance Form This form is intended to capture the DBE subcontractor's2 description of work to be performed and the price of the work submitted to the prime contractor. An EPA Financial Assistance Agreement recipient must require Its prime contractor to have its DBE subcontractors complete this form and include all completed forms in the prime contractor's bid or proposal package. Subcontractor Name Project Name FY 2023 CIP PIPELINING PHASE IVA3 CONTRACT NO. 1063 Bid/Proposal 1063 No, Assistance Agreement (if known) ID No. Point of Contact Address Telephone No, Email Address Prime Contractor Name Insituform Technologies USA, LLC Issuing/Funding Entity Contract Item Number Description of Work Submitted to he Prime Contractor Construction, Services, Equipment or Supplies Involving Price of the Work Submitted to Prime Contractor it /t.1...QleS t e'r ,t !/P'r - wS t'e 01f-tW k.., ei- DBE Certified Other: by DOT SBA Meets/exceeds EPA certification YES NO standards? Unknown IA DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts certification as described In 40 CFR 33.204-33.205 or certified by EPA. EPA accepts certifications from entities that meet or exceed EPA certification standards as described in 40 CFR 33.202. 2Subcontractor is defined as a company, firm, Joint venture, or Individual who enters Into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance. IASRE6100-3 DBE Subcontractor Performance Form — Page 1 SRF-7 January 2021 Disadvantaged Business Enterprise Program DBE Subcontractor Performance Form I certify under penalty of perjury that the forgoing statements are true and correct. Signing this form does not signify a commitment to utilize the subcontractors above. I am aware of that in the event of a replacement of a subcontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302 (c). Prime Contractor Signature Print Name �/; dc. Jana Lause Title Date Contrating & Attesting Officer June 9, 2022 Subcontractor Signature Print Name Title Date IASRF6100.3 DBE Subcontractor Performance Form — Page 2 SRF-8 January 2021 Attachment 5 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid if utilizing DBE subcontractors) Disadvantaged Business Enterprise Program DBE Subcontractor Utilization Form This form is intended to capture the prime contractors actual and/or intended use of identified certified DBE' subcontractors2 and the estimated dollar amount of each subcontract. An EPA Financial Assistance Agreement Recipient must require its prime contractors to complete this form and include it in the bid or proposal package. Prime contractors should also maintain a copy of this form on file. Prime Contractor Name Insituform Technologies USA, LLC Project FY Name 2023 CIP PIPELINING PHASE IVA3 CONTRACT NO, 1063 Bid/Proposal No. 1063 Assistance Agreement ID No. (if known) Point of Contact Address 580 Goddard Avenue, Chesterfield, MO 63005 Telephone No. 636-530-8000 Email Address jlause@aegion.com Issuing/Funding Entity I have identified potential DBE certified subcontractors If yes, please complete the table below. If no, please explain: YES NO Subcontractor Name/Company Name Company Address/Phone/Emall Estimated Dollar Amount Currently DBE Certified? _.-_ . /(..4 a ¥ffh2 h _, .._ /7 m qit 0H reed v dL- __ ontinue on back if needed 'IA DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts certification as described in 40 CFR 33.204-33.205 or certified by EPA, EPA accepts certifications from entities that meet or exceed EPA certification standards as described in 40 CFR 33.202. 2Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance. IASRF6100-4 DBE Subcontractor Utilization Form — Page 1 SRF-9 January 2021 Disadvantaged Business Enterprise Program DBE Subcontractor Utilization Form I certify under penalty of perjury that the forgoing statements are true and correct. Signing this form does not signify a commitment to utilize the subcontractors above. I am aware of that in the event of a replacement of a subcontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302 (c). Prime Contractor Signature Print Name A 0. Jana Lause Title Date Contrating & Attesting Officer June 9, 2022 IASRF6100-4 DBE Subcontractor Utilization Form — Page 2 SRF-10 January 2021 Attachment 10 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid) PROHIBITION ON CERTAIN TELECOMMUNICATIONS AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT This term and condition implements 2 CFR 200.216 and is effective for obligations and expenditures of EPA financial assistance funding on or after 8/13/2020, EPA recipients and subrecipients, including borrowers under EPA funded revolving loan fund programs, are prohibited from obligating or expending loan or grant funds to: (a) Procure or obtain, extend or renew a contract to procure or obtain; (b) Enter into a contract (or extend or renew a contract) to procure; or (c) Obtain the equipment, services, or systems that use "covered telecommunications equipment or services" identified in the regulation as a substantial or essential component of any system, or as critical technology as part of any system. Certain equipment, systems, or services, including equipment, systems, or services produced or provided by entities subject to the prohibition are recorded in the System for Award Management exclusion list, website: https://www.sam.gov/SAM/. (1) As described in Public Law 115-232, section 889, covered telecommunications equipment or services includes: (i) Telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities). (11) For the purpose of public safety, security of government facilities, physical security surveillance of critical infrastructure, and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities). (iii) Telecommunications or video surveillance services provided by such entities or using such equipment. (iv) Telecommunications or video surveillance equipment or services produced or provided by an entity that the Secretary of Defense, in consultation with the Director of the National Intelligence or the Director of the Federal Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country. (2) Consistent with 2 CFR 200.471, costs incurred for telecommunications and video surveillance services or equipment such as phones, Internet, video surveillance, and cloud servers are allowable except for the following circumstances: (i) Obligating or expending EPA funds for covered telecommunications and video surveillance services or equipment or services to procure (enter into, renew or extend contracts) or obtain the equipment, services, or systems as described in 2 CFR 200.216. I understand the above prohibitions and certify that the project will be in compliance with all the requirements. Jana Lause, Contracting & Attesting Officer Typed Name & Title of Authorized Representative June 9, 2022 Signature of Authorized Representative Date SRF-34 January 2021 AEGIONI Stronger. Safer. Infrastructure: Insituform" INSITUFORM TECHNOLOGIES USA, LLC PRESIDENT APPONTMENT OF CONTRACTING AND ATTESTING OFI'ICERS 580 Goddard Avenue Chesterfield, MO 63005 Phone: (636) 530-8000 Pox: (636)898-5078 unvw,nagion.com The undersigned, being the President of Insituform Technologies USA, LLC, a Delaware Limited Liability Company (the "Company"), and pursuant to the authority set forth in the Liinited Liability Company Operating Agreement of the Company, hereby determines that: I. Christlanda Adkins, Janet Hass, Jana Lause, Diane Partridge, Whittney Schulte, and Ursula Youngblood are appointed as Contracting and Attesting Officers of the Cotnpany, each with the authority, individually and in the absence of the others, subject to the control of the Board of Managers of the Company, to: (i) certify and attest to the signature of any officer of the Company; (ii) enter into and bind the Company to perform pipeline rehabilitation activities of the Company and all matters related thereto, including the maintenance of one or more offices and facilities of the Company; (iii) execute and to deliver documents on behalf of the Company; and (iv) take such other action as is or may be necessary and appropriate to carry out the project, activities and work of the Company. 2. Any person previously appointed or serving as a Contracting and Attesting Officer of the Company prior to the date hereof and who is not named above is hereby removed from any such appointment. Dated: ' March 25, 2022 Burt M. ICe President AEGION Stronger. Safe . Infrast u ture: Insituform* Chrissy Koller 580 Goddard Avenue Chesterfield, MO 63005 314-343-9152 June 9, 2022 Subject: Waterloo IA FY 2023 CIP Pipelining Phase IVA3 To Whom It May Concern, Insituform Technologies, USA LLC has solicited subcontractor quotes from a number of DBE/MBE/WBE contractors to meet the goals for this project. These contractors specialize in Water and sewer line and related structures construction. Of the list contractors solicited (please see attached), no one responded to provide us pricing for the project. I have included documentation which shows details of Insituform's good faith efforts in soliciting DBE/MBE/WBE subcontractors for this project. Please find the attached spreadsheet detailing contractors contacted along with a copy of the emails that were sent. I have also included a copy of the advertisement that I posted on Bid Ocean search site for contractors located on htips://www.bidoceanxorrif This advertisement was posted on 5/24/2022. We have received no responses from the posting from any contractors. Again, Insituform Technologies, USA LLC will not be able to meet the DBE/MBE/WBE goals for this project. Please accept this documentation as our good faith effort in meeting the goals on this project. Sincerely, Ovv t.YLG. or. *'O-uuu Chrissy Koller Senior Sales Administrator Insituform Technologies USA, LLC 5/24/22, 2:48:PM Bld Ocean - Classifieds - My Ads Select your search criteria: Keyword: State: { v l 0 Active 0 Not Active Add classified In this category / If you have not found appropiate category you can request adding new one Search Items For Sale Items Wanted Services Available Services Wanted Help Wanted MBE/WBE Available MBE/WBE Wanted Employment Public Ads 0of0 0of0 0of0 Oof0 Oof0 Oof0 4 classifieds found DBEIMBEIWBE (edit) State(s): WI Hello, added: 03/25/22 edited: 05/23/22 Insituform Technologies USA, LLC Intends to bid as a prime contractor on the upcoming project titled New Auburn WI Pine Street Sewer Lining. We are seeking proposals from registered minority companies. Insituform Technologies USA LLC, an Aeglon Company is an Equal opportunity Employer. We would be happy to work with your firm In breaking down these bid items to assist in your ability to quote some of this work. If you need to obtain bonds, lines of credit or insurance as required, assistance is available. 4 of 12 0 of 0 You may download a copy of the bid documents by using the link below. If you wish to provide us with a quote, please note that they are due by Friday, May 27, 2022 at 9AM CST. Please submit quotes to ckoller@aeglon.com and/or rkramer@aegion.com. Please see link below for a copy of specs and plans: New Auburn WI Pine St Sewer Lining 06 01 2022 We would appreciate a quote from your firm. Please contact us with any questions regarding this project at 314-343-9152. Thank you. DBE Contractors wanted -Request for Quotes (edit) State(s): IA RE Contract No: City of Waterloo IA FY 2023 CIP Pipelining Phase IVA3 Contract No. 1063 Dear Contractors: added: 03/17/22 edited: 05/24/22 Insituform Technologies USA, LLC Is presently soliciting for the following work in connection with the above referenced project. Please see below for bid Items that we would like quotes for: Also below is the link to view all specs and plans for this project. Link to specs and plans: Waterloo IA (CK) CIP Pipelining Phase IVA3 06 09 2022 Insituform Technologies USA, LLC Is an Equal Opportunity Employer, and all qualified bidders will not be discriminated against due to race, religion, color, sex or origin. If interested, your proposal must be turned in as well as attached information above via email by Friday, June 3, 2022 at 9:00 AM CST. Please send quotes with attached documents to mwarner@aegion.com and/or ckoller@aegion.com Please contact us to obtain required forms that are to be filled out and returned with your quote. Thank you, Chrissy Koller I Senior Sales Administrator I Insituform Technologies, LLC 580 Goddard Avenue I Chesterfield, MO 63005 Office: 636.530.8610 pen: 314.343.9152 IFax: 636.898,5094 j www.Aegion.com ckoller@aeglon.com DBE Contractors wanted -Request for Quotes (edit) added: 03/17/22 edited: 04/29/22 https://www.bIdocean.com/cfieds_mylndex. php?cal=67&wanted=1 1/2 5/24/22, 2:48 PM Bid Ocean - Classifieds - My Ads State(s): WI Hello, Insituform Technologies USA, LLC Intends to bid as a prime contractor on the upcoming project titled Arena WI 2022 Sewer & Lift Station Improvements Proposal B. We are seeking proposals from registered minority contractors through the Iowa DOT. Insituform Technologies USA LLC, an Aegion Company is an Equal opportunity Employer. We would be happy to work with your firm In breaking down these bid items to assist In your ability to quote some of this work. If you need to obtain bonds, lines of credit or insurance as required, assistance is available. You may download a copy of the bid documents by using the link below. If you wish to provide us with a quote, please note that they are due by Monday May 23, 2022 at 9AM CST. Please submit quotes to ckoller@aeglon.com and/or rkramer@aegion.com. Please see link below for a copy of specs and plans: https://aegion.sharepoint.com/:f:/s/is/bd/bid/EkH_31 Tf-K5CmjmuPDbKgj4BQcr2yWPHkOnMFrLRZOT5ow? e=GxbNhL We would appreciate a quote from your firm. Please contact us with any questions regarding this project at 314-343-9152. Thank you. DBE Contractors -Request for Quotes (edit) added: 03/17/22 edited: 04/25/22 State(s): MI Hello, Insituform Technologies USA, LLC intends to bid as a prime contractor on the upcoming project titled Marysville MI CWSRF Sanitary Sewer Improvements. We are seeking proposals from registered DBE/MBE/WBE firms certified through the Michigan DOT and/or Sams.gov sites to assist In the completion of this project. Insituform Technologies USA LLC, an Aegion Company is an Equal opportunity Employer. We would be happy to work with your firm in breaking down these bid items to assist in your ability to quote some of this work. If you need to obtain bonds, lines of credit or Insurance as required, assistance Is available. You may download a copy of the bid documents by using the link below. If you wish to provide us with a quote, please note that they are due by Monday, May 9, 2022 at 9AM EST. Please submit quotes tojferguson@aegion.com and/or kmetz@aegion.com Please see link below for a copy of specs and plans: https://aeg ion.sharepoint.com/:f:/s/is/bd/bid/E uodFg7 bxmZH h kT2h h oa6aEBfLSazPtM Fdg Rxe74BRq s8Q? e=DLrcm3 We would appreciate a quote from your firm. Please contact us with any questions regarding this project at 317-408-7136. Thank you. Copyright © 2000 - 2022 Bid Ocean, Inc. https://www.bidocean.com/cfieds_mylndex.php?cat=67&wanted=l 2/2 Christina Koller From: Christina Koller Sent: Tuesday, May 31, 2022 2:51 PM Cc: Mark Warner Subject: Second and Final Reminder --Request for Quotes -Waterloo IA FY 2023 CIP Pipelining Phase IVA3 Attachments: Attachment 4.pdf; Waterloo -letter of intent to bid -return with quote.pdf Tracking: Recipient Mark Warner dsa@acot.us.com karinkee3@gmail.com ddpatterson@delonginc.com sharazin@gmcontractinginc.com christina@gunterkc.com is nda constru ction 2013 @gma il.com jennifer@jjboring.com info@kimconstruction.com ap@pwsmn.com anne@mIdstatesrebarsupply.com midwestbores@gmail.com diaztapmaster@gmail.com propavinglIc06@gmall.com deb@toppert.com Read Read: 5/31/2022 2:52 PM **Second and Final Reminder: RE: Contract No: City of Waterloo IA FY 2023 CIP Pipelining Phase IVA3 Contract No. 1063 Dear Contractors: Insituform Technologies USA, LLC is presently soliciting for the following work in connection with the above referenced project. Please see below for bid items that we would like quotes for: Also below is the link to view all specs and plans for this project. The following are Items from the FY 2023 CIP PIPELINING PHASE IVA3, CITY CONTRACT NO. 1063, that have a potential for MBE/WBE Participation. This listing, however, Is not Intended to be all encompassing; to preclude MBE/WBE Contractors from bidding on any Items of the Proposal as a Subcontractor or the entire Proposal as a Prime Contractor. BID ITEM DESCRIPTION UNIT EST. QTY. 8" Diameter CIP Pipe Lining IF 16,824.0 2 10" Diameter CIP Pipe Lining IF 5,084.0 3 12" Diameter CIP Pipe Lining IF 1,735.0 4 Lateral Reinstatement EA 333.0 5 3-FT Lateral Grouting EA 333.0 6 Pipe Televising - 8" LF 33,648.0 7 Pipe Televising - 10" LF 10,168.0 8 Pipe Televising - 12" IF 3,470.0 9 Type A Pipe Cleaning - 8" IF 16,824.0 10 Type A Pipe Cleaning - 10" IF 5,084.0 11 Type A Pipe Cleaning - 12" LF 1,735.0 12 Type C Root Removal - 8"-10" IF 10,954.0 13 Type C Root Removal - 12"-15" IF 867.0 14 Type D Lumberjack - 8"-10" LF 10,954.0 15 Type D Lumberjack - 12" - 15" LF 867.0 16 Protruding Taps Removal EA 50.0 Link to specs and plans: El Waterloo IA f CK}CIP NpeliningPhase VA3 06 09 2022 Insituform Technologies USA, LLC is an Equal Opportunity Employer, and all qualified bidders will not be discriminated against due to race, religion, color, sex or origin. If interested, your proposal must be turned in as well as attached information above via email by Friday, June 3, 2022 at 9:00 AM CST. Please send quotes with attached documents to mwarner@aegion.com and/or ckailer@aegfon.com, Thank you, Chrissy Koller I Senior Sales Administrator I Insituform Technologies, LLC 580 Goddard Avenue I Chesterfield, MO 63005 Office: 636.530.8610 I Cell: 314.343.9152 I Fax: 636.898.5094 I www.Aegion.eom ck«allereaepinn,c0m Insituform' Stronger. Safer. Infrastructure.` Aegion is the parent company of Aegion Coating Services AIISafe Services, 13rmderson Corrpro Companies, Environmental Techniques, Fibrwrap Construction Services, Insituform Technologies M]C Schultz Underground Solutions and United Pipeline Systems 2 Christina Koller From: Microsoft Outlook To: dsa@acot.us.com; karinkee3@gmail.com; ddpatterson@delonginc.com; sharazin@gmcontractinginc.com; christina@gunterkc.com; iandaconstruction2013 @gmail.com;Iennifer@jjboring.com; info@kimconstruction.com, ap@pwsmn.com; anne@midstatesrebarsupply.com; midwestbores@gmail.com; diaztapmaster@gmail.com, propavingllc06@gmail.com; deb@toppert.com Sent: Tuesday, May 24, 2022 2:48 PM Subject: Relayed: Request for Quotes --Waterloo IA FY 2023 CIP Pipelining Phase IVA3 Delivery to these recipients or groups is complete, but no delivery notification was sent by the destination server: cisalpacot.us.corn (dsa a acot,us.com) karinkee3©gmail.com(karinke_e3@grnail corn) ddpatterson@delori inc com (ddpatterson@delonpinc.com) sharazin@glpcontractinginc.com_(sh.araz @_Cmcontracunginc.com) Christina@y.unterkc.com (christinaC@unterkc.corn_) ranch_c_onstruct.ion2013@grna 1.com__(i<tndaconstruction)0_i3(agmail.corn_) renn fer_©jjborind,corn(tennifer©thjrbori_n_g,com) infoC@>kimconstructian_com jnfo@kimconstructioncom) ap@pwsmn.com__(a.Opwsmn,com) anne midstatcsrebarsupply.com (anne@midstate_srebarsup_nly.corn) midwestbores.@gmail.com (midwestbores@gmail,_c_om). diaztapmaster@gmail,,com (diaztaprnaster_@gmatl.corn). propavingllc06@gmail.corn (propavvingllc06© grnaiLcorn) deIDtoppert.Com_ (deb@toppert.corn) Subject: Request for Quotes --Waterloo IA FY 2023 CIP Pipelining Phase IVA3 Request for Quotes--Waterl... 1 Christina Koller From: To: Sent: Subject: Your message Sue Harazin <sharazin@gmcontractinginc.com> Christina Koller Tuesday, May 24, 2022 3:04 PM Read: Request for Quotes --Waterloo IA FY 2023 CIP Pipelining Phase IVA3 To: Subject: Request for Quotes --Waterloo IA FY 2023 CIP Pipelining Phase IVA3 Sent: Tuesday, May 24, 2022 8:04:18 PM (UTC+00:00) Monrovia, Reykjavik was read on Tuesday, May 24, 2022 8:04:04 PM (UTC+00:00) Monrovia, Reykjavik. Christina Koller From: Sent: To: Subject: Anne Moore <anne@acepipe.com> Thursday, May 26, 2022 3:02 PM Christina Koller [EXTERNAL] Automatic reply: Second and Final Reminder --Request for Quotes New Auburn WI Pine Street Sewer Lining Hello. I will be out of the office starting on Thursday, May 26th. I will be back in the office on Tuesday. Thank you. Anne Moore Christina Koller From: Sent: Cc: Subject: Attachments: Christina Koller Tuesday, May 24, 2022 2:48 PM Mark Warner Request for Quotes --Waterloo IA FY 2023 CIP Pipelining Phase IVA3 Attachment 4.pdf; Waterloo -letter of intent to bid -return with quote.pdf RE: Contract No: City of Waterloo IA FY 2023 CIP Pipelining Phase IVA3 Contract No. 1063 Dear Contractors: Insituform Technologies USA, LLC is presently soliciting for the following work in connection with the above referenced project. Please see below for bid items that we would like quotes for: Also below is the link to view all specs and plans for this project. The following are Items from the FY 2023 CIP PIPELINING PHASE IVA3, CITY CONTRACT NO. 1083, that have a potential for MBE/WBE Participation. This listing, however, is not Intended to be all encompassing; to preclude MBE/WBE Contractors from bidding on any items of the Proposal as a Subcontractor or the entire Proposal as a Prime Contractor. 81D ITEM DESCRIPTION UNIT ' EST. QTY. 1 8" Diameter CIP Pipe Lining LF 16,824.0 2 10" Diameter CIP Pipe Lining LF 5,084.0 3 12" Diameter CIP Pipe Lining LF 1,735.0 4 Lateral Reinstatement EA 333.0 5 3-FT Lateral Grouting EA 333.0 6 Pipe Televising - 8" LF 33,648.0 7 Pipe Televising - 10" LF 10,168,0 8 Pipe Televising - 12" LE 3,470.0 9 Type A Pipe Cleaning - 8" LF 16,824,0 10 Type A Pipe Cleaning - 10" LF 5,084,0 11 Type A Pipe Cleaning - 12" LF 1,735.0 12 Type C Root Removal - 8"-10" LF 10,954,0 13 Type C Root Removal - 12"-15" LF 867.0 14 Type D Lumberjack - 8"-10" LF 10,954.0 15 Type D Lumberjack - 12" - 15" LF 867.0 16 Protruding Taps Removal EA 50.0 Link to specs and plans: rl Waterloo IALCK1_CIP Piielinin� Phase_ IVA306 09 2022 Insituform Technologies USA, LLC is an Equal Opportunity Employer, and all qualified bidders will not be discriminated against due to race, religion, color, sex or origin. If interested, your proposal must be turned in as well as attached information above via email by Friday, June 3, 2022 at 9:00 AM CST. Please send quotes with attached documents to mwarner «saepion.com and/or ckol er( aegioncorn 1 Thank you, Chrissy Koller I Senior Sales Administrator I Insituform Technologies, LLC 580 Goddard Avenue I Chesterfield, MO 63005 Office: 636.530.8610 I Cell: 314.343.9152 I Fax: 636.898.5094 1 www.Aef oon_corn c koller 3)a egion_corn Insituform Stronger. Safer. Intrastruclure. Aegion is the parent company of Aegion Coating Services, AllSafe Services, 8nnderson, Corrpro Companies, Environmental Techniques, Fibrwrap Construction Services, Insituform Technologies MTC, Schultz Underground Solutions and United Pipeline Systems Christina Koller From: Microsoft Outlook To: dsa@acot.us.com; karinkee3@gmail.com; ddpatterson@delonginc.com; sharazin@gmcontractinginc.com, christina@gunterkc.com; iandaconstruction2013 @gmail.com,jennifer@jjboring.com; info@kimconstruction.com; ap@pwsmn.com, anne@midstatesrebarsupply.com; midwestbores@gmail.com, diaztapmaster@gmail.com, propavingllc06@gmail.com; deb@toppert.com Sent: Tuesday, May 31, 2022 2:51 PM Subject: Relayed: Second and Final Reminder --Request for Quotes -Waterloo IA FY 2023 CIP Pipelining Phase IVA3 Delivery to these recipients or groups is complete, but no delivery notification was sent by the destination server: dsa@acot,us.cor_n_(dsu@acot.rrs,com) Icarinkee3@gmail.com (karinkee3 gmcom) ddp_lterrson@delonginc.corn (ddpatterson@delnnginc.cam) shara In(pigmcontractingrnc.com_(sharazin_@gmcontractn_ginc.com) cltristinaggunterkc.com (christina@gunterkc.co_m� rand aenstruction20 t3@gmail.corn(iandaconstruction2013@g_mail.corn) Jennifer @jjboring com_(rennifer@>jjhoring.com) info[uuikimconstruction.com (info@kirnconstructiori.corn) aP©pwsmn.com (ap@pwsrnn_co_m) anne@midstaiesrebarsupply.com (armed,m_idstatesrebarsupply.com) rnidweslbores@gmail.corn (midwestbQres@gmail _com) diaztapmaster©gmaikon] (diaztapmaster@gmail.com) prop ry nglld_)6 simail.com (propavingllc06 ra gmmil.com) debt©toppert.corn (del>)toppert.com) Subject: Second and Final Reminder --Request for Quotes -Waterloo IA FY 2023 CIP Pipelining Phase IVA3 Second and Final Reminder--Req... 1 Christina Koller From: Solomon Akinduro <dsa@acot.us.com> To: Christina Koller Sent: Tuesday, May 31, 2022 5:10 PM Subject: Read: Second and Final Reminder --Request for Quotes -Waterloo IA FY 2023 CIP Pipelining Phase IVA3 Your message To: Subject: Second and Final Reminder --Request for Quotes -Waterloo IA FY 2023 CIP Pipelining Phase IVA3 Sent: Tuesday, May 31, 2022 10:09:58 PM (UTC+00:00) Monrovia, Reykjavik was read on Tuesday, May 31, 2022 10:09:41 PM (UTC+00:00) Monrovia, Reykjavik.