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REVISED JUNE 17, 2013 RETURN WITH BID <br /> Bidder is currently certified as an MBE or WBE under EPA's DBE program? Yes No x <br /> (If An Individual) <br /> Signature of Bidder N/A Title: <br /> (SEAL) <br /> Business Address N/A <br /> Telephone # N/A E-Mail Address <br /> ' If a Co-Partnership) <br /> P) <br /> N/A <br /> Firm Name Title: <br /> (SEAL) <br /> By: N/A Title: <br /> ' Business Address N/A <br /> ' Telephone# N/A E-Mail Address <br /> Names of All N/A <br /> Members of Firm <br /> (If a Corporation) <br /> Insituform echn ogies USA, LLC <br /> Corporate Name ($EAL) <br /> ' By: C - <br /> ] t Denise Carroll, Assistant Secretary <br /> Business Address 17988 Edison Ave, Chesterfield, MO 63005 <br /> Telephone# 636.530.8000 E-Mail Address dcarroll@insituform.com <br /> Names of <br /> Officers J. Joseph Burgess <br /> President <br /> David Morris <br /> ' Secretary <br /> Kenneth Young <br /> ' Treasurer <br /> Attest: <br /> Joann Smith, ssist t Secretary <br /> ' CITY 2012-06/BGM 12-043 PROP-18 <br />