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b. Such insurance shall include the following endorsements as further
detailed in the Endorsements Section below:
e Additional Insured.
e Primary and Non-Contributory wording.
e Waiver of Subrogation.

Product Liability for products and completed operations coverage of at least
$10 million for a period of five (5) years after acceptance of the last Low
Floor Cutaway Van delivered under this contract.

Property Insurance Property and/or transit insurance, whichever is
applicable, with Special Form coverage including theft but excluding
earthquake, with limits at least equal to the replacement cost of the property
described below.
a. The insurance shall include coverage for, but not be limited to:
e Contractor’s own business personal property and equipment
to be used in performance of this Contract.
e Materials or property to be purchased and/or installed on
behalf of the City of Nashua, if any.
e Debris removal.
e Builders’ risk for property in the course of construction.
b. Such insurance shall include the following endorsement as further
detailed in the Endorsements Section below:
e Waiver of Subrogation.

2. Endorsements
Additional Insured The referenced policies and any Excess or Umbrella
policies shall include as Additional Insureds the City of Nashua and its directors,
officers, employees, volunteers and agents while acting in such capacity, and their
successors or assignees, as__ they now, or as they may hereafter be constituted,
singly, jointly or severally.

Waiver of Subrogation The referenced policies and any Excess or Umbrella
policies shall contain a waiver of subrogation in favor of the City of Nashua and
its officers, directors, employees, volunteers and agents while acting in such
capacity, and their successors and _ assignees, as they now, or as they may
hereafter be constituted , singly, jointly or severally.

Primary Insurance The referenced policies and any Excess or Umbrella
policies shall indicate that they are primary to any other insurance and the
insurance company(ies) providing such policy(ies) shall be liable thereunder
for the full amount of any loss or claim, up to and including the total limit of
liability, without right of contribution from any of the insurance affected or which
may be affected by the City of Nashua.

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3. Evidence of Insurance
All Coverages — Prior to commencing work, Seller shall provide the City of
Nashua with a certificate of insurance evidencing coverage, and upon
request, acertified | duplicate original of the policy. The certificate shall also
show that the Contractor’s _ policy(ies) will not be cancelled or coverage altered
without 30 days prior written notice to the City of Nashua.

4. General Provisions
Notice of Cancellation — The policies shall provide that the Contractor’s
policies will not be cancelled or have limits reduced or coverage altered
without 30 days prior written notice to the City of Nashua.

Acceptable Insurers — All policies will be issued by insurers with a Best’s
Rating of A- 10 or better.

Self-Insurance — Upon evidence of financial capacity satisfactory to the City
of Nashua and Contractor’s agreement to waive subrogation against the City of
Nashua respecting any and all claims that may arise, Contractor’s obligation
hereunder may be satisfied in whole or in part by adequately funded self-
insurance.

Failure to Maintain Insurance — All insurance specified above shall remain
in force until all work to be performed is satisfactorily completed and the work
has been formally accepted. The failure to procure or maintain required
insurance and/or an adequately funded self-insurance program will constitute
a material breach in of this Contract.

Occurrence Coverage — Insurance shall be provided on an occurrence basis
and not a claim-made basis.
Deductibles and Retentions — Seller shall be responsible for payment of any

deductible or retention on Contractor’s policies without right of contribution
from the City of Nashua.

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EXHIBIT C - FORMS

THE FOLLOWING PAGES MUST BE FILLED

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Date:

Firm:

FTA BUS TESTING CERTIFICATION

I. NEW BUS MODEL TO BE TESTED

In accordance with 49 CFR Part 665, “Bus Testing Program,” the Proposer certifies that the bus
model being proposed for this Contract is a new bus model or a bus model with a major change in
configuration or components (as described in Subpart A of the interim rule). Bidder, at its own
expense, will arrange for the required testing at the FTA Bus Testing Facility at Altoona,
Pennsylvania prior to the Authority’s acceptance of the first vehicle in a manner that the Time for
Performance outlined in the Contract Specifications will not be impacted. Sellerwill provide a copy
of the Test Report prepared for this bus model prior to acceptance.

OR

Il. BUS MODEL ALREADY TESTED

In accordance with 49 CFR Part 665, “Bus Testing Program,” the Proposer certifies that the bus
model being proposed for this Contract is not a new bus model and does not incorporate a major
change in configuration or components (as described in Subpart A of the interim rule). The
Sellerwill provide, upon request of the Authority, a copy of the Test Report prepared for the bus
model accepted under this Contract.

(CHECK ONE BOX ONLY)

Signature:

Title:

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CERTIFICATE OF

TVM DBE

COMPLIANCE

(TO BE FILLED OUT BY MANUFACTURER’S OF ROLLING STOCK ONLY)
In connection with the contract to be awarded as a result of the invitation to bid issued by the Nashua Transit
System:

| hereby certify that the (name of company) has complied with
the requirements of 49 CFR 26, participation by Disadvantage Business in DOT Programs, and that our goals
have not been disapproved by the Federal Transit Administration.

Name of Company

Signature of Authorized Official

Name and Title of Authorized Official

Date

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BUY AMERICA CERTIFICATE OF COMPLIANCE WITH FTA
REQUIREMENTS FOR BUSES, OTHER ROLLING STOCK,
OR ASSOCIATED EQUIPMENT

(To be submitted with a bid or offer exceeding the small purchase threshold for Federal
assistance programs, currently set at $150,000.)

Certificate of Compliance

The bidder hereby certifies that it will comply with the requirements of 49 U.S.C.
Section 5323()(2)(C), Section 165(b)(3) of the Surface Transportation Assistance
Act of 1982, as amended, and the regulations of 49 CFR 661.11:

Date:

Signature:

Company Name:

Title:

Certificate of Non-Compliance

The bidder hereby certifies that it cannot comply with the requirements of 49 U.S.C. Section
5323(j)(2)(C) and Section 165(b)(3) of the Surface Transportation Assistance Act of 1982,
as amended, but may qualify for an exception to the requirements consistent with 49
U.S.C. Sections 5323(j)(2)(B) or (j)(2)(D), Sections 165(b)(2) or (b)(4) of the Surface
Transportation Assistance Act, as amended, and regulations in 49 CFR 661.7.

Date:

Signature:

Company Name:

Title:

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Federal Motor Vehicle Safety Standards

The Proposer and (if selected) Seller shall submit (1) manufacturer's FMVSS self-certification sticker
information that the vehicle complies with relevant FMVSS or (2) manufacturer’s certified statement that the
contracted buses will not be subject to FMVSS regulations.

Company name:
Name of signer:
Title:

Authorized signature Date

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Certification Regarding Debarment, Suspension,
Ineligibility and Voluntary Exclusion

- Lower Tier Covered Transaction

(1) The prospective lower tier participant certifies, by submission of this bid or proposal, that neither it
nor its "principals" [as defined at 49 CFR § 29.105(p)] is presently debarred, suspended, proposed
for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by
any Federal department or agency.

(2) When the prospective lower tier participant is unable to certify to the statements in this certification,
such prospective participant shall attach an explanation to this proposal.

The bidder respondent and all subcontractors hereby certifies that he/she has not been debarred or
suspended from participation in Federal contracts. Please note - separate certification may be photo
copied and submitted by each subcontractor. (Pursuant to 49 CFR, Part 29)

CERTIFIED (Contractor) CERTIFIED (Sub-Contractor(s))
| | | |
Company Company
| | | |
Signed By Signed By
| | | |
Name & Title Name & Title
| | | |
Date Date

DISCLOSURE OF LOBBYING ACTIVITIES

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The undersigned [Contractor] certifies, to the best of his or her knowledge and belief, that:

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee of
an agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the awarding of any Federal contract, the making of
any Federal grant, the making of any Federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any
person for making lobbying contacts to an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned
shall complete and submit Standard Form--LLL, "Disclosure Form to Report Lobbying," in
accordance with its instructions [as amended by "Government wide Guidance for New
Restrictions on Lobbying," 61 Fed. Reg. 1413 (1/19/96). Note: Language in paragraph (2)
herein has been modified in accordance with Section 10 of the Lobbying Disclosure Act of
1995 (P.L. 104-65, to be codified at 2 U.S.C. 1601, ef seq.)]

(3) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts
under grants, loans, and cooperative agreements) and that all subrecipients shall certify and
disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making or
entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying
Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a
civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

{[Note: Pursuant to 31 U.S.C. § 1352(c)(1)-(2)(A), any person who makes a prohibited expenditure
or fails to file or amend a required certification or disclosure form shall be subject to a civil penalty
of not less than $10,000 and not more than $100,000 for each such expenditure or failure.]

The Seller certifies or affirms the truthfulness and accuracy of each statement of its certification
and disclosure, if any. In addition, the Seller understands and agrees that the provisions of 31
U.S.C. A 3801, ef seq., apply to this certification and disclosure, if any.

Executed this day of , 20

Name of Bidder

Address

City/State/Zip

Name of Contractor's Authorized Official Signature of Contractor's Authorized Official

Title of Contractor's Authorized Official

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DELINQUENT PERSONAL PROPERTY STATEMENT

, hereby affirms under oath, pursuant to New Hampshire State
Code, that at the time the bid was submitted by_(company) was / was not (please circle one) charged with
delinquent personal property taxes on the General Tax List of Personal Property for Hillsborough County, New
Hampshire.

If such charge for delinquent personal property tax exists on the General Tax List of Personal Property for
Hillsborough County, New Hampshire, the amount of such due and unpaid delinquent taxes, including due
and unpaid penalties and interest shall be set forth below. A copy of this statement shall be transmitted to
the Hillsborough County Treasurer within thirty (30) days of the date it is submitted. If a contract is entered
into, a copy ofthis statement shall also be incorporated into the contract between NTS and the bidder and no
payment shall be made with respect to any contract unless such statement has been so incorporated as a
part thereof.

Delinquent Personal Property Tax *

Company

Signed By

Name & Title

Date

State of

County of

SWORN TO BEFORE ME THIS DAY OF. ,20_.

NOTARY PUBLIC
SEAL

MY COMMISSION EXPIRES

* Mark “N/A’ if not applicable
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