NOXVILLE TILITIES OARD CONTRACTOR RE- UALIFICATIONS .

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KNOXVILLE UTILITIES BOARDCONTRACTOR PRE-QUALIFICATIONSContractor Pre-Qualification StatementSection A; General Company InformationDate Submitted by Contractor:Date Received by KUB:(To be filled out by KUB upon Receipt)Basic Company InformationLegal Name of Business:Street Address (Not a P.O. Box):City:State:Zip CodePrincipal (headquarters) Office Mailing Address:City:StateAdmin. Contact Name:Zip Code:Phone No.:Admin. Contact Email:Fax No.:Company Website URL:Company Federal ID#:Number of Years Company has been in Business:Average number of employees in your principal office for the last two years:Current yearOfficeCraftsTOTALPrior yearOfficeCraftsTOTALList the local branch office(s) that will serve the KUB territory (attach additional sheet if necessary):Revised 05.24.21Company NameBranch Manager/City, State, ZipPhone NumberContractor Pre-Qualification Statement – Section A GeneralNo. of EmployeesOfficeCraftsPage 1 of 5

KNOXVILLE UTILITIES BOARDCONTRACTOR PRE-QUALIFICATIONSContact Information for Company Principals List Individuals who will be Submitting Bids and SigningContracts. List All that apply.Name of Owner or Owner’s Representative:Phone No.:E-Mail.:Name of Company President:Phone No.:E-Mail.:Name of Company Vice President:Phone No.:E-Mail.:Name of Bid and Contract Signing Authority 1:Title:Phone No.:E-Mail.:Office Address of Signing Authority 1:Name of Bid and Contract Signing Authority 2:Title:Phone No.:E-Mail.:Office Address of Signing Authority 2:Name of Bid and Contract Signing Authority 3:Title:Phone No.:E-Mail.:Office Address of Signing Authority 3:Revised 05.24.21Contractor Pre-Qualification Statement – Section A GeneralPage 2 of 5

KNOXVILLE UTILITIES BOARDCONTRACTOR PRE-QUALIFICATIONSPrequalification Classifications Contractor’s Company is Applying for: (Check all that apply. Note:Unlimited categories require unlimited bonding status and at least 5 years of experience on similar projects among otherevaluation criteria. Contact KUB Procurement for further details if in doubt which categories to apply for)KUB 2.0 Wastewater Division2.1 Wastewater Testing and Inspection Services, Includes: Smoke Test, Line Cleaning, Chemical and Mechanical RootControl, TV Inspection, Dye Testing, Flow Testing and Monitoring, Utility Locating, Site Video Recording, Lab Services.2.2 Wastewater Utility Construction, Unlimited: Includes Conventional Trenching for Pipe and Manhole Installation,Manhole Restoration, Pipebursting, CIPP, Auger Boring and Tunneling, Point Repairs, Pump Station Construction andRehabilitation. Includes Participation in Categories 2.3, 2.4 and 3.2.2.3 Wastewater Pipeline Construction, 225,000.00 Bid Limit and Nominal 12 inch and under pipe size: IncludesConventional Trenching for Pipe and Manhole Installation, Manhole Restoration, Pipebursting, CIPP(subject to approval),Auger Boring and Tunneling, Point Repairs2.4 Wastewater Pump Station Construction, 225,000.00 Bid Limit per Lump Sum Pump Station Item: Includes 4MGDand smaller Pump Station construction, replacement, or rehabilitation, and includes Odor Control Facilities. Electrical workto be 600VAC and below.2.5 Wastewater Plant Construction, Unlimited: Includes all facets of Wastewater Plant, Pump Station, and FacilityConstruction, Rehabilitation, and Repair. (Certain Large scale projects may require project specific prequalification and aresubject to separate requirements) Includes Participation in Categories 2.4, 2.6, 3.5 and 3.6.2.6 Wastewater Plant Construction, 175,000.00 Bid Limit: Includes Plant Repairs, Upgrades, Small Projects andSubsystem Specific Work. Pipework to be 12 inches nominal size and below. Electrical work to be 600VAC and below.Includes Participation in Category 3.6KUB 3.0 Water Division3.1 Water System Testing and Inspection Services, Flow Testing and Monitoring, Leak Detection Services, UtilityLocating, Site Video Recording, Hydrant Services (Inspection, Flow Testing, Flushing), Meter Services (Inspection, Testing,Repair, Replacement).3.2 Water Utility Construction, Unlimited: Includes Conventional Trenching, Pipebursting, and Boring (Auger, PipeRamming, and Directional Drilling) for Installation of all Pipe Sizes. Includes Construction of Water Pressure BoosterStations. Includes Participation in Categories 3.3, 3.4 and 2.2.3.3 Water Utility Construction, 225,000.00 Bid Limit and Nominal 8 inch and under pipe size: Includes ConventionalTrenching, Pipebursting, and Boring (Auger, Pipe Ramming, and Directional Drilling). Includes Construction of WaterPressure Booster Stations. Includes Participation in Category 3.43.4 Water Utility Construction, No Bid Limit and Nominal 2 inch and under pipe size: Includes Conventional Trenching,Pipebursting, and Boring (Auger, Pipe Ramming, and Directional Drilling). Includes Construction of Water PressureBooster Stations with inlet and outlet connections of 2 inch and under pipe size. This category serves the galvanized linereplacement initiative.3.5 Water Plant Construction, Unlimited: Includes all facets of Water Plant, Booster Station, Facility and Storage TankConstruction, Rehabilitation, and Repair. (Certain Large scale projects may require project specific prequalification and aresubject to separate requirements) Includes Participation in Categories 3.6, 2.5 and 2.6.3.6 Water Plant Construction, 175,000.00 Bid Limit: Includes Plant Repairs, Upgrades, Small Projects and SubsystemSpecific Work. Pipework to be 12 inches nominal size and below. Electrical work to be 600VAC and below. IncludesParticipation in Category 2.6Revised 05.24.21Contractor Pre-Qualification Statement – Section A GeneralPage 3 of 5

KNOXVILLE UTILITIES BOARDCONTRACTOR PRE-QUALIFICATIONSKUB 4.0 Gas Division4.1 Gas System Testing and Inspection Services, Leak Testing and Monitoring, Utility Locating, Site Video Recording,Meter Services (Inspection, Testing, Repair, Replacement).4.2 Gas Utility Construction, Unlimited: Includes Conventional Trenching and Boring (Auger and Directional Drilling)for Installation of all Pipe Sizes and materials as specified. Includes Construction of Gas Pressure Regulator Stations,Mainline Construction, Commercial and Residential Service lines.4.3 Gas Utility Construction, No Bid Limit and Nominal 4 inch and under pipe sizes in HDPE material: IncludesConventional Trenching and Boring (Auger or Directional Drilling), Mainline Construction, Commercial and ResidentialService lines.KUB 5.0 Electric Division5.1 Electric System Testing and Inspection Services, Pole Inspection, Line Inspection, Utility Locating, Site VideoRecording, Meter Testing and Repair.5.2 Electric Utility Construction, Unlimited 161KV: Includes all Construction and Maintenance of KUB Overhead andUnderground Electric Distribution and Transmission Systems up to 161KV. (Certain Large scale projects may requireproject specific prequalification and are subject to separate requirements) Includes Participation in Categories 5.3, 5.5 and5.6.5.3 Electric Utility Construction, 225,000.00 Bid Limit and 13.2KV: Includes all Construction and Maintenance of KUBOverhead and Underground Electric Distribution System up to 13.2KV. Includes setting pad mounted and overheadtransformers, primary and secondary wiring and connections for residential and light commercial applications. IncludesParticipation in Category 5.6.5.4 Electric Utility Substation Construction, Unlimited: Includes all Construction and Upgrades to KUB Substations andSubstation Systems (Substation projects may require project specific prequalification and are subject to separaterequirements)5.5 Electric Utility Construction, Unlimited 600VAC: Includes all Construction, Maintenance, and Renovation of KUBElectric Systems up to 600VAC. Includes Plant, Pump Station, and Street Lighting Applications. Includes Participation inCategories 5.6.5.6 Electric Utility Construction, 225,000.00 Bid Limit and 600VAC limit: Includes all Construction, Maintenance, andRenovation of KUB Electric Systems up to 600VAC. Includes Plant, Pump Station, and Street Lighting Applications.Revised 05.24.21Contractor Pre-Qualification Statement – Section A GeneralPage 4 of 5

KNOXVILLE UTILITIES BOARDCONTRACTOR PRE-QUALIFICATIONSKUB 6.0 Vegetation Management Program6.1 Vegetation Management Program Support Services, Includes: Work preplanning services, scheduling, fieldinspections, reporting, customer notification and response, and other program support functions and services. This categorycannot be combined with 6.2, 6.3, 6.4, or 6.5.6.2 Overhead Electric Line Tree Pruning and Clearing, Unlimited: Includes tree pruning, tree and brush removal andherbicide application in close proximity to energized overhead electrical lines up to 161 kV per ANSI A300 and ANSI Z133standards. Includes qualification for all work in Categories 6.3, and 6.4.6.3 Non-electric Tree Work, Clearing, Mowing, and Herbicide Application: Planned work assigned by project includingbut not limited to tree pruning, select tree removal, stump removal, brush cutting (mechanical and manual), weed control,herbicide application, clearing to ground, chipping, disposal, and other related work per ANSI A300 and ANSI Z133standards. Excludes: Tree pruning and clearing within the minimum approach distance for energized overhead electricallines.6.4 Will Call: Short notice on call, small project, quick turnaround work including but not limited to: Individual treepruning, removing and clearing downed trees, individual or multiple tree or stump removal, , brush removal (standing ordown), site or spot cleanup, raking, haul off, and other related smaller scale work per ANSI A300 and ANSI Z133 standards.Excludes: Tree pruning and clearing within the minimum approach distance for energized overhead electrical lines6.5 Tree Planting: Planned work assigned by project including tree planting per ANSI A300 (Part 6) standardsKUB 7.0 Paving7.2 Municipal City Street and Roadway Paving, Unlimited: Includes but not limited to city streets, alley ways, Countyroadways surface preparations, improvements, surface milling, straight line truing, overlay patching, tack coat applications,asphalt placement, curb to curb finish course overlay, rolling, compaction, finish milling, burn in, inspection, site clean up,traffic control and any other paving related scope of work performed in accordance with the City of Knoxville, KnoxCounty, TDOT or other governing agencies per the project specification requirements.KUB 8.0 Fiber8.1 Fiber Optic System Outside Plant Construction, Unlimited: Includes all Construction and Maintenance of KUBoverhead and underground fiber optic systems. Including placement of steel messenger strand and lashing of fiber opticcable, conventional trenching and boring (auger and directional drilling) of communication conduits and placement of fiberoptic cable.8.2 Fiber Optic System Outside Plant Construction, 150,000 bid limit: Includes all Construction and Maintenance of KUBoverhead and underground fiber optic systems. Including placement of steel messenger strand and lashing of fiber opticcable, conventional trenching and boring (auger and directional drilling) of communication conduits and placement of fiberoptic cable.8.3 Fiber Optic Outside Plant Fusion Splicing and Testing: Includes all construction and maintenance fiber optic fusionsplicing and testing of KUB’s outside plant Fiber Optic Network. Splicing to include splicing single strand and mass fusionsplicing, reel end and ring cut splices, and network access point (NAP) or (terminal) splicing. Testing to include light loss,OTDR, and polarization testing on optical paths.Revised 05.24.21Contractor Pre-Qualification Statement – Section A GeneralPage 5 of 5

KNOXVILLE UTILITIES BOARDCONTRACTOR PRE-QUALIFICATIONSContractor Pre-Qualification StatementSection B; Financial, Bonding, License, Insurance, InformationDate Submitted by Contractor:Date Received by KUB:(To be filled out by KUB upon Receipt)Section B Information for (Company Name):1.FINANCIAL INFORMATION (KUB reserves the right to request a copy of Firm’s most recent audited financial statement.)Value of Assets Owned by Firm: Annual Sales Volume for the three most recently completed Fiscal Years: (Indicate Year and Dollar Volume)FY 20 FY 20 FY 20 Largest Single Contract in the last 3 years: 2.BONDING INFORMATION (Projects require a 100% Performance Bond and a 100% Payment Bond. TheSurety shall consent and yield to the jurisdiction of the State Civil Courts of Knox County, Tennessee)3.LICENSE INFORMATIONAttach a photocopy of Contractor’s current valid State of Tennessee Contractor’s License.4.INSURANCE INFORMATION (Insurance Certificate with limits stipulated will be detailed in the biddingdocuments)Can the contractor provide a basic certificate of insurance?YesNoDoes Contractor have, or is eligible to obtain, Railroad Liability Insurance, if required?YesNoDoes Contractor have, or is eligible to obtain, Environmental Pollution Liability insurance, if required?5.YesNoYesNoVERIFCATION OF BUSINESS STATUS MINORITY AND WOMEN OWNED BUSINESSIs Contractor classified as minority or women owned business?Revised 05.24.21Contractor Pre-Qualification Statement – Section B Financial, License, InsurancePage 1 of 1

KNOXVILLE UTILITIES BOARDCONTRACTOR PRE-QUALIFICATIONSContractor Pre-Qualification StatementSection C; Safety Information1. Name of Firm:Date:Submitted By:Title:2.List your firm’s Worker’s Compensation experience modification rates (EMR) for the last three years, and provide aletter from your Comp. Carrier verifying these rates.Year20RatePolicy NumberCarrier20203. List your firm’s OSHA incidence rates for the last three years and attach OSHA 200/300 logs for last 3 yearsProvide the incidence numbers and rates, including employee numbers and hours worked, for the entries in thetable below by using your OSHA Form No. 300. Using the formulas provided calculate OSHA Incidence Rates.Data will be checked against that recoded and provided on the submitted copies of your OSHA 300 logs.CategoriesPART 1. USE THE FORMULA BELOW TOCOMPLETE THE LAST TWO ENTRIES OF THISTABLE.202020a. Fatalitiesb. Number of cases involving days away fromwork, restrictions, or transfers (DART cases)c. Number of days away from workd. Number of non-fatal cases without daysaway from work, restrictions, or transfersAverage number of employeesNumber of hours workede. Total OSHA recordable cases (injury &illness)No.RateNo.RateNo.RateNumber of recordable cases x 200,000 hrs. Incidence RateNumber annual hours workedf.OSHA recordable cases that resulted inDART casesNumber DART (b) cases x 200,000 hrs. Incidence RateNumber annual hours workedDo you have a written safety program?.Revised 05.24.21YesContractor Prequalification Statement - Section C Health and Safety InformationNoPage 1 of 1

Revised 05.24.21 Contractor Pre-Qualification Statement – Section A General Page 1 of 5 . NOXVILLE. U. TILITIES. B. OARD. C. ONTRACTOR. P. RE-Q. UALIFICATIONS. Contractor Pre-Qualification Statement . Section A; General Company Information . Date Submitted by Contractor: Dat