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IN WITNESS WHEREOF, this instrument is executed in counterparts, each one of which shall be deemed
an original this day of , 20

ATTEST:
(PRINCIPAL)
BY:
(Principal) Secretary
BY:
(ADDRESS)
BY:
Witness as to Principal
(ADDRESS)
(SURETY)
ATTEST: BY:
(ATTORNEY in FACT)
BY:
Witness to Surety (ADDRESS)

NOTE: Date of BOND must not be prior to date of Contract.
If CONTRACTOR is partnership, all partners should execute BOND.

IMPORTANT: Surety companies executing BONDS must appear on the Treasury Department's most current list (Circular
570 as amended) and be authorized to transact business in the State of New Hampshire.

Page 8 of 15

NOTICE TO PROCEED

Dated , 20
TO:
(Insert Name of Contractor as it appears in the Bid Documents)
ADDRESS:
OWNER’S PROJECT NO. N/A
PROJECT: Siphon Rehabilitation Project
OWNER’S CONTRACT NO. __IFBO779-071422
CONTRACT FOR: Siphon Rehabilitation Project
You are notified that the Contract Time under the above contract will commence to run on , 20

By that date, you are to start performing your obligations under the Contract Documents. In accordance with paragraph 3
of the Agreement, the dates of Substantial Completion and Final Completion are , 20

and ,20___ respectively.

Before you may start any Work at the site, paragraph 27 of the General Conditions provides that you and Owner must
each deliver to the other (with copies to ENGINEER) certificates of insurance which each is required to purchase and
maintain in accordance with the Contract Documents. Also before you may start any Work at the site, you must:

Copy to ENGINEER
(Use Certified Mail, return receipt Requested) OWNER:

By:

(Authorized Representative)

NAME:

(Title)

ACKNOWLEDGEMENT OF NOTICE
Receipt of the above NOTICE TO PROCEED is hereby acknowledged by:

(Contractor)

This the , day of 20_, by

Employee Identification Number:

Page 9 of 15

CHANGE ORDER

No.
PROJECT NAME: Siphon Rehabilitation Project DATE OF ISSUANCE:
OWNER: City of Nashua, NH OWNER PROJECT NO. IFBO779-071422
ADDRESS: 229 Main Street Nashua, NH 03060
Street Name City/Town State ZIP
CONTRACTOR:
CONTRACT FOR:
ENGINEER:
ENGINEER: Hazen and Sawyer ENGINEER PROJ NO. 90006-034
ADDRESS: 1750 Elm Street, Suite 402 Manchester, NH 03101
Street Name City/Town State ZIP
You are directed to make the following changes in the Contract Documents.
Description:
Purpose of Change Order:
Justification:
Attachments: (List documents supporting change)
CHANGE IN CONTRACT PRICE CHANGE IN CONTRACT TIME
Original Contract Price Original Contract Time
| days | | date
Previous Change Orders Net change from previous Change Orders
| days | | date
Contract Price prior to this Change Order Contract Time prior to this Change Order
| days | | date
Net Increase (Decrease) of this Change Order Net Increase (decrease) this Change Order
| days | | date
Contract Price with all approved Change Orders Contract Time with all Change Orders
| days | | date

This document will become a supplement to the CONTRACT and all provisions will apply hereto. The attached
Contractor’s Revised Project Schedule reflects increases or decreases in Contract Time as authorized by this Change
Order.

Stipulated price and time adjustment includes all costs and time associated with the above described change. Contractor
waives all rights for additional time extension for said change. Contractor and Owner agree that the price(s) and time
adjustment(s) stated above are equitable and acceptable to both parties.

RECOMMENDED BY: APPROVED BY: APPROVED BY: APPROVED BY:
Engineer Owner Contractor NHDES
Date Date Date Date

Page 10 of 15

CERTIFICATE OF SUBSTANTIAL COMPLETION

Owner Project No. —1IFBO779-071422 Engineer Project No. 90006-034
Project: Siphon Rehabilitation Project

Contractor:

Contract For: Siphon Rehabilitation Contract Date:

This Certificate of Substantial Completion applies to all work under the Contract Documents or to the following specified
parts thereof:

To

(Owner)

And to

(Contractor)

The Work to which this Certificate applies has been inspected by authorized representatives of OWNER, CONTRACTOR
and ENGINEER, and that Work is hereby declared to be substantially complete in accordance with the Contract
Documents on Documents on

(Date of Substantial Completion)

A tentative list of items to be completed or corrected is attached hereto. This list may not be all-inclusive, and the failure
to include an item in it does not alter the responsibility of CONTRACTOR to complete all the work in accordance with the
Contract Documents. The items in the tentative list shall be completed or corrected by CONTRACTOR within

calendar days of the above Substantial Completion.

The responsibilities between OWNER and CONTRACTOR for security, operation, safety, maintenance, heat, utilities,
insurance and warranties shall be as follows:

RESPONSIBILITIES:
OWNER:

CONTRACTOR:

The following documents are attached to and made a part of this Certificate:

Page 11 of 15

This certificate does not constitute an acceptance of work not in accordance with the Contract Documents nor is it a
release of CONTRACTOR's obligation to complete the work in accordance with the Contract Documents.

Executed by the Engineer on , 20
(Engineer)
By:
CONTRACTOR accepts this Certificate of Substantial Completion on , 20
(Contractor)
By:
OWNER accepts this Certificate of Substantial Completion on , 20
(Owner)
By:

Page 12 of 15

NHDES-W-09-015

—- CERTIFICATE OF FINAL COMPLETION

—— '\ DEPARTMENT OF

Environmental NHDES CLEAN WATER AND DRINKING WATER

SS ——_ Services STATE REVOLVING FUND

Owner Project No. —1IFBO779-071422 Engineer Project No. 90006-034
Project: Siphon Rehabilitation project

Owner: City of Nashua, NH

Contractor:

Engineer:

Agreement Date:

Notice to Proceed Date:

Contractual Substantial Completion
date as modified by change orders:

Actual Substantial Completion date

Contractual final completion date
as modified by Change Orders

The work to which this certificate applies has been inspected by authorized representatives of Owner, Contractor,

Engineer and NHDES, the punch list has been completed and the work of the contract is hereby declared to be Finally
Complete in accordance with the Contract Documents on

(Date of Final Completion)
This certificate does not constitute an acceptance of any work not in accordance with the Contract Documents nor is it a
release of contractor’s obligation to complete the work in accordance with the Contract Documents. The warranty for all

work completed subsequent to the date of Substantial Completion expires one year from the date of this Final
Acceptance.

Executed by Engineer on ,20__

By:

Contractor Accepts this Certificate of Final Completion on , 20 __

By:

Owner Accepts this Certificate of Final Completion on , 20 __

By:

NHDES Accepts this Certificate of Final Completion on ,20__

By:

Page 13 of 15

CONTRACTORS AFFIDAVIT

STATE OF:
COUNTY OF:

Before me the undersigned a (Notary Public, Justice of the Peace,
Alderman) in and for said County and State Personally appeared (Individual, partner or duly)

who being duly sworn according to law deposes and says that the cost of all the Work, and outstanding claims and

indebtedness of whatever nature arising out of the performance of the Contract between City of Nashua, NH (Owner)

and (Contractor) of

(Contractor Address) dated for the construction of the Siphon Rehabilitation Project (Project Name)

and necessary appurtenant installations have been paid in full.

(Individual, Partner, or duly authorized representative of corporate contractor)

(Title)

Sworn to and subscribed before me
this day of ,20__

(Notary Public)

Page 14 of 15

CONTRACTOR’S FINAL RELEASE AND WAIVER OF LIEN

Project Name: Siphon Rehabilitation Project
Project Address: 229 Main Street Nashua NH 03060
City/Town State ZIP
Owner Name: City of Nashua, New Hampshire
Contractor Name:
Contractor Address:
City/Town State ZIP

TO ALL WHOM IT MAY CONCERN:

For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the undersigned
Contractor hereby waives, discharges, and releases any and all liens, claims, and rights to liens against the above-
mentioned project, and any and all other property owned by or the title to which is in the name of the above-referenced
Owner and against any and all funds of the Owner appropriated and available for the construction of said project, and
any and all warrants drawn upon or issued against any such funds or monies, which the undersigned Contractor may have
or may hereafter acquire or process as a result of the furnishing of labor, materials and/or equipment, and the
performance of work by the Contractor on or in connection with said project, whether under and pursuant to the above-
mentioned contract between the Contractor and the Owner pertaining to said project or otherwise, and which said liens,
claims or rights of lien may arise and exist.

The undersigned further hereby acknowledges that the sum of:

Dollars ($ ) constitutes the entire unpaid balance due the under
said contract or otherwise and that the payment of said sum to the contractor will constitute payment in full and will fully
satisfy any and all liens, claims, and demands which the contractor may have or assert against the owner in connection
with said contract or project.

Dated this day of 20__
(Contractor)
Witness to Signature
BY: BY:
Title Title

Page 15 of 15

City of Nashua

Purchasing Department

Administrative Services Division (603) 589-3330
229 Main Street - Nashua, NH 03060 Fax (603) 594-3233
September 1, 2022
Memo #23-324
TO: Mayor Donchess
Finance Committee
SUBJECT: 2022 Sewer Siphon Rehabilitation Construction Services in the amount not to exceed

$192,876 funded from 81700 Infrastructure Improvements/Bond

Please see attached communications from Daniel Hudson, City Engineer, dated July 28, 2022 for project
specific details related to this purchase. Below please find a summary of the purchase approval request:

Item: Siphon Rehabilitation Construction Services
Value: $192,876
Vendor: Hazen and Sawyer

Department: 169 Wastewater
Source Fund: 81700 Infrastructure Improvements/ Bond

Ordinance: Pursuant to NRO § 5-83 Professional Services (A) In the purchase of accounting,
architectural, auditing, engineering, legal, medical and ambulance services and purchases of independent
professional consultant services for personnel, data processing, actuarial, planning, management and
other comparable purchases competitive bidding shall not be required.

The Board of Public Works (08/25/2022 BPW meeting), Division of Public Works: Wastewater, and the
Purchasing Department respectfully request your approval of this contract.

Regards,

Amy Girard

Purchasing Manager

Ce: D Hudson
C O'Connor
K Kleiner

To:

From:

Re:

C. Motion:

Discussion:

City of Nashua, Public Works Division
Board of Public Works Meeting Date: August 25, 2022

Daniel Hudson, P.E., City Engineer
Engineering Department

2022 Sewer Siphon Rehabilitation Construction Services

To approve the construction administration contract for sewer siphons
rehabilitation with Hazen and Sawyer, PC of Manchester, NH in an amount of
$192,876. Funding will be through Department: 169 Wastewater; Fund: Bond;
Activity: Sewer Improvements.

Hazen and Sawyer was selected as the engineering consultant to complete Phase |
of the Capacity, Management, Operation and Maintenance (CMOM) program.
During that project, eight locations where inverted sewer siphons convey
wastewater from one side of a waterway to the other side were cleaned and
inspected using closed circuit television (CCTV). The siphons are comprised of 22
sewer sections totaling 4,700 feet in length, are made of various materials, and
range in diameter from 6 inches to 60 inches. The siphons were originally
constructed between 1965 and 1982.

Fourteen of the 22 sections in the siphons ranging in size from 8 inches to 36 inches
were identified with deficiencies that include cracks, erosion of cement lining,
corrosion, holes, and exposed rebar. Hazen provided the proposed design using
methods of pipe lining to rehabilitate the pipes and has the necessary expertise to
provide construction administration to ensure proper construction methods are
followed by the contractor.