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The preceding provisions include, in part, certain Standard Terms & Conditions required by USDOT, whether or
not expressly stated in the preceding contract provisions. All USDOT required contractual provisions, as stated
in FTA Circular 4220.1F, are hereby incorporated by reference. Anything to the contrary herein notwithstanding,
all FTA mandated terms shall be deemed to control in the event of a conflict with other provisions contained in
this contract. The Contractor shall not perform any act, fail to perform any act, or refuse to comply with any
request that would cause the City to be in violation of FTA terms and conditions.

7. Environmental Resource Conservation and Energy Conservation.

(a) Energy Conservation.

Contractor shall comply with mandatory standards and policies relating to energy efficiency that are
contained in the New Hampshire energy conservation plan issued in compliance with the Energy Policy and
Conservation Act, 42 U.S.C. § 6321 et seq.

(b) Clean Air.

1. Contractor shall comply with all applicable standards, orders or regulations pursuant to Section 306 of
the Clean Air Act, as amended, 42 U.S.C. § 7606, and other requirements of the Clean Air Act, as
amended, 42 U.S.C. §§ 7401 — 7671q. Contractor shall report each violation to the City and
understands and agrees that the City will, in turn, report each violation as required to FTA and the
appropriate EPA Regional Office.

2. Contractor shall include these requirements in each subcontract exceeding $100,000 financed in whole
or in part with FTA assistance.

(c) Clean Water

1. Contractor shall comply with all applicable standards, orders or regulations issued pursuant to Section
508 of the Clean Water Act, as amended, 33 U.S.C. § 1368, and other requirements of the Clean
Water Act, as amended, 33 U.S.C. §§ 1251 - 1377. Contractor shall report each violation to the City
and understands and agrees that the City shall, in turn, report each violation as required to FTA and
the appropriate EPA Regional Office.

2. Contractor shall include these requirements in each subcontract exceeding $100,000 financed in whole
or in part with FTA assistance.

8. Compliance with Laws & Federal Changes. Contractor shall comply with all applicable laws,
ordinances, codes, rules, regulations, programs, plans, and orders in the performance of the Contract
Documents. Without limiting the foregoing, Contractor shall comply with all applicable FTA regulations, policies,
procedures and directives, including without limitation those listed directly or by reference in the Master
Agreement between the City and FTA, as they may be amended or promulgated from time to time during the
term of the contract. Contractor's failure to comply shall constitute a material breach of the contract.

9. Debarment and Suspension.

(a) The Contractor agrees to comply with the requirements of Executive Order Nos. 12549 and 12689,
“Debarment and Suspension,” 31 U.S.C. Section 6101 note; and USDOT regulations on Debarment and
Suspension and 49 CFR Part 29.

(b) Unless otherwise permitted, the Contractor agrees to refrain from awarding any third-party contract of any
amount to or entering into any subcontract of any amount with a party included in the “U.S. General
Services Administration’s (U.S. GSA) List of Parties Excluded from Federal procurement and Non-
procurement Program,” implementing Executive Order Nos. 12549 and 12689, “Debarment and
Suspension” and 49 CFR Part 29. The list also include the names of parties debarred, suspended, or
otherwise excluded by agencies, and contractors declared ineligible for contract award under statutory or
regulatory authority other than Executive Order Nos. 12546 and 12689.

(c) Before entering into any subcontracts with any subcontractor, the Contractor agrees to obtain a debarment
and suspension certification from each prospective recipient containing information about the debarment
and suspension status and other specific information of that awarding agency and its “principals,” as
defined at 49 CFR Part 29.

(d) Before entering into any third-party contract exceeding $25,000.00, the Contractor agrees to obtain a
debarment and suspension certification from each third-party contractor containing information about the
debarment and suspension status of that third-party contractor and its “principals,” as defined at 49 CFR
29.105(p). The Contractor also agrees to require each third party contractor to refrain from awarding any
third-party subcontract of any amount, at any tier, to a debarred or suspended subcontractor, and to obtain
a similar certification for any third-party subcontractor, at any tier, seeking a contract exceeding $25,000.00.

10.Buy America

The contractor agrees to comply with 49 U.S.C. 5323(j) and 49 C.F.R. part 661, which
provide that Federal funds may not be obligated unless all steel, iron, and manufactured
products used in FTA funded projects are produced in the United States, unless a waiver
has been granted by FTA or the product is subject to a general waiver.

The contractor must submit to the City the appropriate Buy America certification below with
its bid. Bids or offers that are not accompanied by a completed Buy America certification will
be rejected as nonresponsive.

In accordance with 49 C.F.R. § 661.6, for the procurement of steel, iron or manufactured
products, use the certifications below.

Certificate of Compliance with Buy America Requirements

The bidder or offeror hereby certifies that it will comply with the requirements of 49 U.S.C.
5323(j)(1), and the applicable regulations in 49 C.F.R. part 661.

Date:

Signature:

Company:

Name:

Title:

Certificate of Non-Compliance with Buy America Requirements

The bidder or offeror hereby certifies that it cannot comply with the requirements of 49 U.
5323(j), but it may qualify for an exception to the requirement pursuant to 49 U.
5323(j)(2), as amended, and the applicable regulations in 49 C.F.R. § 661.7.

Date:

S.C.
S.C.

Signature:

Company:

Name:

Title:

11.Fly America Requirements.
For contracts involving transportation of persons or property, by air between the U.S. and/or places outside the

U.S. These requirements do not apply to micro-purchases ($3,500 or less, except for construction contracts
over $2,000).

Contractor shall comply with 49 USC 40118 (the “Fly America’ Act) in accordance with General Services
Administration regulations 41 CFR 301-10, stating that recipients and subrecipients of Federal funds and their
contractors are required to use US Flag air carriers for US Government-financed international air travel and
transportation of their personal effects or property, to the extent such service is available, unless travel by
foreign air carrier is a matter of necessity, as defined by the Fly America Act. Contractor shall submit, if a
foreign air carrier was used, an appropriate certification or memorandum adequately explaining why service by
a US flag air carrier was not available or why it was necessary to use a foreign air carrier and shall, in any
event, provide a certificate of compliance with the Fly America requirements. Contractor shall include the
requirements of this section in all subcontracts that may involve international air transportation.

12. Seismic Safety

The contractor agrees that any new building or addition to an existing building will be designed and constructed
in accordance with the standards for Seismic Safety required in Department of Transportation Seismic Safety
Regulations 49 CFR Part 41 and will certify to compliance to the extent required by the regulation. The
contractor also agrees to ensure that all work performed under this contract including work performed by a
subcontractor is in compliance with the standards required by the Seismic Safety Regulations and the
certification of compliance issued on the project.

13.Cargo Preference Requirements

The Maritime Administration (MARAD) regulations at 46 C.F.R. § 381.7 contain suggested contract clauses.
Recipients can draw on the following language for inclusion in their federally funded procurements.

Cargo Preference - Use of United States-Flag Vessels - The contractor agrees:

a. to use privately owned United States-Flag commercial vessels to ship at least 50 percent of the gross
tonnage (computed separately for dry bulk carriers, dry cargo liners, and tankers) involved, whenever shipping
any equipment, material, or commodities pursuant to the underlying contract to the extent such vessels are
available at fair and reasonable rates for United States-Flag commercial vessels;

b. to furnish within 20 working days following the date of loading for shipments originating within the United
States or within 30 working days following the date of loading for shipments originating outside the United
States, a legible copy of a rated, "on-board" commercial ocean bill-of-lading in English for each shipment of
cargo described in the preceding paragraph to the Division of National Cargo, Office of Market Development,
Maritime Administration, Washington, DC 20590 and to the FTA recipient (through the contractor in the case of
a subcontractor's bill-of-lading.); and

c. to include these requirements in all subcontracts issued pursuant to this contract when the subcontract may
involve the transport of equipment, material, or commodities by ocean vessel.

14. Bonding
Please see Bonding Language in Article 8 of the Agreement

15. Employee Protections

Prevailing Wage and Anti-Kickback

For all prime construction, alteration or repair contracts in excess of $2,000 awarded by FTA, the
Contractor shall comply with the Davis-Bacon Act and the Copeland “Anti-Kickback” Act. Under 49

U.S.C. § 5333(a), prevailing wage protections apply to laborers and mechanics employed on FTA assisted
construction, alteration, or repair projects. The Contractor will comply with the Davis-Bacon Act,

40 U.S.C. §§ 3141-3144, and 3146-3148 as supplemented by DOL regulations at 29 C.F.R. part 5, “Labor
Standards Provisions Applicable to Contracts Governing Federally Financed and Assisted Construction.”
In accordance with the statute, the Contractor shall pay wages to laborers and mechanics at a rate not
less than the prevailing wages specified in a wage determination made by the Secretary of Labor. In
addition, the Contractor agrees to pay wages not less than once a week. The Contractor shall also
comply with the Copeland “Anti-Kickback’ Act (40 U.S.C. § 3145), as supplemented by DOL regulations
at 29 C.F.R. part 3, “Contractors and Subcontractors on Public Building or Public Work Financed in Whole
or in part by Loans or Grants from the United States.” The Contractor is prohibited from inducing, by any
means, any person employed in the construction, completion, or repair of public work, to give up any

part of the compensation to which he or she is otherwise entitled.

Contract Work Hours and Safety Standards

(a) Overtime requirements — Neither the Seller or any subcontractors contracting for any part of the contract work
which may require or involve the employment of laborers or mechanics shall require or permit any such laborer
or mechanic in any workweek in which he or she is employed on such work to work in excess of 40 hours in such
workweek unless such laborer or mechanic receives compensation at a rate not less than one and one-half times
the basic rate of pay for all hours worked in excess of 40 hours in such workweek.

(b) Violation; liability for unpaid wages; liquidated damages - In the event of any violation of the clause set forth
in para. (1) of this section, Seller and any subcontractor responsible therefore shall be liable for the unpaid
wages. In addition, Seller and such subcontractor shall be liable for liquidated damages. Such liquidated
damages shall be computed with respect to each individual laborer or mechanic, including watchmen and
guards, employed in violation of the clause set forth in para. (1) of this section, in the sum of $10 for each
calendar day on which such individual was required or permitted to work in excess of the standard workweek of
40 hours without payment of the overtime wages required by the clause set forth in para. (1) of this section.

(c) Withholding for unpaid wages and liquidated damages - the City shall upon its own action or upon written
request of USDOL withhold or cause to be withheld, from any moneys payable on account of work performed
by Seller or subcontractor under any such contract or any other Federal contract with the same prime
contractor, or any other federally assisted contract subject to the Contract Work Hours & Safety Standards Act,
which is held by the same prime contractor, such sums as may be determined to be necessary to satisfy any
liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the
clause set forth in para. (2) of this section.

(4) Subcontracts - Seller or subcontractor shall insert in any subcontracts the clauses set forth in this section
and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. Prime
contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses
set forth in this section.

16. Recycled Products

The Contractor agrees to provide a preference for those products and services that conserve

natural resources, protect the environment, and are energy efficient by complying with and facilitating
compliance with Section 6002 of the Resource Conservation and Recovery Act, as amended, 42 U.S.C. §6962,
and U.S. Environmental Protection Agency (U.S. EPA), “Comprehensive Procurement Guideline for Products
Containing Recovered Materials,” 40 C.F.R. part 247.

17.Dispute Resolution

The parties shall attempt to resolve any dispute related to this Contract as follows. Either party shall provide to
the other party, in writing and with full documentation to verify and substantiate its decision, its stated position
concerning the dispute. No dispute shall be considered submitted and no dispute shall be valid under this
provision unless and until the submitting party has delivered the written statement of its position and full
documentation to the other party. The parties shall then attempt to resolve the dispute through good faith
efforts and negotiation. Unless otherwise directed by the City, at all times Seller shall continue performance
under the Contract Documents while matters in dispute are being resolved. If the parties are unable to resolve
their dispute as described above within 30 days, the parties’ reserve the right to pursue any available legal
and/or equitable remedies for any breaches of this contract except as that right may be limited by the terms of
this Contract.

Should either party to the Contract suffer injury or damage to person or property because of any act or omission
of the party or of any of its employees, agents or others for whose acts it is legally liable, a claim for damages
therefore shall be made in writing to such other party as soon as practicable after the first observance of such
injury or damage.

Duties and obligations imposed by the Contract Documents and the rights and remedies available thereunder
shall be in addition to and not a limitation of any duties, obligations, rights and remedies otherwise imposed or
available by law.

18. DOL EEO Clause for Construction Projects

Per 41 C.F.R. Chapter 60, which implement Executive Order 11246, “Equal Employment
Opportunity,” September 24, 1965, as amended by Executive Order 11375, “Amending Executive
Order 11246 Relating to Equal Employment Opportunity,” October 13, 1967.

DURING THE PERFORMANCE OF THIS CONTRACT, THE CONTRACTOR AGREES AS
FOLLOWS:

(1) THE CONTRACTOR WILL NOT DISCRIMINATE AGAINST ANY EMPLOYEE OR
APPLICANT FOR EMPLOYMENT BECAUSE OF RACE, COLOR, RELIGION, SEX, SEXUAL
ORIENTATION, GENDER IDENTITY, OR NATIONAL ORIGIN. THE CONTRACTOR WILL
TAKE AFFIRMATIVE ACTION TO ENSURE THAT APPLICANTS ARE EMPLOYED, AND
THAT EMPLOYEES ARE TREATED DURING EMPLOYMENT WITHOUT REGARD TO
THEIR RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION, GENDER IDENTITY, OR
NATIONAL ORIGIN. SUCH ACTION SHALL INCLUDE, BUT NOT BE LIMITED TO THE
FOLLOWING:

EMPLOYMENT, UPGRADING, DEMOTION, OR TRANSFER; RECRUITMENT OR
RECRUITMENT ADVERTISING; LAYOFF OR TERMINATION; RATES OF PAY OR OTHER
FORMS OF COMPENSATION; AND SELECTION FOR TRAINING, INCLUDING
APPRENTICESHIP. THE CONTRACTOR AGREES TO POST IN CONSPICUOUS PLACES,

AVAILABLE TO EMPLOYEES AND APPLICANTS FOR EMPLOYMENT, NOTICES TO BE
PROVIDED SETTING FORTH THE PROVISIONS OF THIS NONDISCRIMINATION CLAUSE.

(2) THE CONTRACTOR WILL, IN ALL SOLICITATIONS OR ADVERTISEMENTS FOR
EMPLOYEES PLACED BY OR ON BEHALF OF THE CONTRACTOR, STATE THAT ALL
QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT
WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION,
GENDER IDENTITY, OR NATIONAL ORIGIN.

(3) THE CONTRACTOR WILL NOT DISCHARGE OR IN ANY OTHER MANNER
DISCRIMINATE AGAINST ANY EMPLOYEE OR APPLICANT FOR EMPLOYMENT
BECAUSE SUCH EMPLOYEE OR APPLICANT HAS INQUIRED ABOUT, DISCUSSED, OR
DISCLOSED THE COMPENSATION OF THE EMPLOYEE OR APPLICANT OR ANOTHER
EMPLOYEE OR APPLICANT. THIS PROVISION SHALL NOT APPLY TO INSTANCES IN
WHICH AN EMPLOYEE WHO HAS ACCESS TO THE COMPENSATION INFORMATION OF
OTHER EMPLOYEES OR APPLICANTS AS A PART OF SUCH EMPLOYEE'S ESSENTIAL
JOB FUNCTIONS DISCLOSES THE COMPENSATION OF SUCH OTHER EMPLOYEES OR
APPLICANTS TO INDIVIDUALS WHO DO NOT OTHERWISE HAVE ACCESS TO SUCH
INFORMATION, UNLESS SUCH DISCLOSURE IS IN RESPONSE TO A FORMAL
COMPLAINT OR CHARGE, IN FURTHERANCE OF AN INVESTIGATION, PROCEEDING,
HEARING, OR ACTION, INCLUDING AN INVESTIGATION CONDUCTED BY THE
EMPLOYER, OR IS CONSISTENT WITH THE CONTRACTOR'S LEGAL DUTY TO FURNISH
INFORMATION.

(4) THE CONTRACTOR WILL SEND TO EACH LABOR UNION OR REPRESENTATIVE OF
WORKERS WITH WHICH HE HAS A COLLECTIVE BARGAINING AGREEMENT OR
OTHER CONTRACT OR UNDERSTANDING, A NOTICE TO BE PROVIDED ADVISING THE
SAID LABOR UNION OR WORKERS' REPRESENTATIVES OF THE CONTRACTOR'S
COMMITMENTS UNDER THIS SECTION, AND SHALL POST COPIES OF THE NOTICE IN
CONSPICUOUS PLACES AVAILABLE TO EMPLOYEES AND APPLICANTS FOR
EMPLOYMENT.

(5) THE CONTRACTOR WILL COMPLY WITH ALL PROVISIONS OF EXECUTIVE ORDER
11246 OF SEPTEMBER 24, 1965, AND OF THE RULES, REGULATIONS, AND RELEVANT
ORDERS OF THE SECRETARY OF LABOR.

(6) THE CONTRACTOR WILL FURNISH ALL INFORMATION AND REPORTS REQUIRED
BY EXECUTIVE ORDER 11246 OF SEPTEMBER 24, 1965, AND BY RULES, REGULATIONS,
AND ORDERS OF THE SECRETARY OF LABOR, OR PURSUANT THERETO, AND WILL
PERMIT ACCESS TO HIS BOOKS, RECORDS, AND ACCOUNTS BY THE ADMINISTERING
AGENCY AND THE SECRETARY OF LABOR FOR PURPOSES OF INVESTIGATION TO
ASCERTAIN COMPLIANCE WITH SUCH RULES, REGULATIONS, AND ORDERS.

(7) IN THE EVENT OF THE CONTRACTOR'S NONCOMPLIANCE WITH THE
NONDISCRIMINATION CLAUSES OF THIS CONTRACT OR WITH ANY OF THE SAID
RULES, REGULATIONS, OR ORDERS, THIS CONTRACT MAY BE CANCELED,
TERMINATED, OR SUSPENDED IN WHOLE OR IN PART AND THE CONTRACTOR MAY
BE DECLARED INELIGIBLE FOR FURTHER GOVERNMENT CONTRACTS OR
FEDERALLY ASSISTED CONSTRUCTION CONTRACTS IN ACCORDANCE WITH
PROCEDURES AUTHORIZED IN EXECUTIVE ORDER 11246 OF SEPTEMBER 24, 1965,
AND SUCH OTHER SANCTIONS MAY BE IMPOSED AND REMEDIES INVOKED AS
PROVIDED IN EXECUTIVE ORDER 11246 OF SEPTEMBER 24, 1965, OR BY RULE,

REGULATION, OR ORDER OF THE SECRETARY OF LABOR, OR AS OTHERWISE
PROVIDED BY LAW.

(8) THE CONTRACTOR WILL INCLUDE THE PORTION OF THE SENTENCE
IMMEDIATELY PRECEDING PARAGRAPH (1) AND THE PROVISIONS OF PARAGRAPHS
(1) THROUGH (8) INEVERY SUBCONTRACT OR PURCHASE ORDER UNLESS
EXEMPTED BY RULES, REGULATIONS, OR ORDERS OF THE SECRETARY OF LABOR
ISSUED PURSUANT TO SECTION 204 OF EXECUTIVE ORDER 11246 OF SEPTEMBER 24,
1965, SO THAT SUCH PROVISIONS WILL BE BINDING UPON EACH SUBCONTRACTOR
OR VENDOR. THE CONTRACTOR WILL TAKE SUCH ACTION WITH RESPECT TO ANY
SUBCONTRACT OR PURCHASE ORDER AS THE ADMINISTERING AGENCY MAY
DIRECT AS A MEANS OF ENFORCING SUCH PROVISIONS, INCLUDING SANCTIONS

FOR NONCOMPLIANCE:
PROVIDED, HOWEVER, THAT IN THE EVENT A CONTRACTOR BECOMES INVOLVED IN, OR IS
THREATENED WITH, LITIGATION WITH A SUBCONTRACTOR OR VENDOR AS A RESULT OF SUCH
DIRECTION BY THE ADMINISTERING AGENCY, THE CONTRACTOR MAY REQUEST THE UNITED
STATES TO ENTER INTO SUCH LITIGATION TO PROTECT THE INTERESTS OF THE UNITED STATES.

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 photocopied and submitted by each
subcontractor. (Pursuant to 49 CFR, Part 29)

Certified (Contractor)

Company

Signed By

Name

Title

Date

Certified (Sub-Contractor(s))

Company

Signed By

Name

Title

Date

DISCLOSURE OF LOBBYING ACTIVITIES

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, ez
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

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. Ifa contract is entered into, a copy of this 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.

B | Delinquent Personal Property Tax *
Is | Penalties *

ls | interest *

ls | Total *

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