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INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This diScosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of
a covered Federai action, or a material change to a previous filing pursuant to title 31 U.S.C. section 1352. The filing of a formis required
for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of
any ag&acy, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a
covered Federal action. Complete all items that apply for both the inital filing and material change report. Refer to the implementing
guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered
Federal action.

2. identify the status of the covered Federal action.

3. Identify the appropriate classification of this report if this a followup report caused by a material change to the information previously
reported, enter the year and quarter in which the change occurred, Enter the date of the last previously submitted report by this
reporting entity for this covered Federal action.

4, Enter the fullname, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the
appropriate classification of the reporting entity that designates if it is, or expects to be a prime or subaward receipt. identify the tier
of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts,
subgrants and contract awards under grants.

5 If the organization filing the report in item 4 checks ‘Subawardee,” then enter the fullname address, city, State and zip code of the
prime Federal recipient. Include Congressional District, if known.

6 Enter the name of the Federal agency making the award or loan commitment. include at least one organizational level below agency
name, if known. For example, Department of Transportation, United States Coast Guard.

7 Enter the Federal program name or description for the covered Federal action (Item 1). If known, enter the full Catalog of Federal
Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments

8. Enter the most appropriate Federal identifying number available for the Federal action identified in Item 1 (¢.9., Request for Proposal
(RFP) number; Invitation for bid (IFB) number; grant announcement number, the contract, grant, or loan award number; the
application/proposal control number assigned by the Federa! agency) Include prefixes, e.g "RFP-DE-90-001."

9. For a covered Federal action where there has been an award or Joan commitment by the Federal agency, enter the Federal amount of
the award/loan commitment for the prime entity identified in tem 4 or 5

10 (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged
by the reporting entity identified in Item 4 to influence the covered Federal action.

(b) Enter the full names of the individual(s) performing services, and include full address if different fram 10 (a) Enter Last Name, First
Name and Middle Initial (MI).

11 Certifying official shail sign and date the form, print his/her name, title and telephone number.

According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless tt displays a valid OMB
Control Number. The vald OMB control number for this information collection is OMB No 0348-0046 Public reporting burden for this collection of
information ts estimated fo average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathenng and
maintaining the data needed, and completing and reviewing the collection of information Send comments regarding the burden estimate or an y olher
aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction
Project (0348-0046), Washington, DC 20503.

04/01/09

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SSD: 06/28/04

ALL FA PROJECTS

SPECIAL ATTENTION

DISADVANTAGED BUSINESS ENTERPRISE (DBE) DIRECTORY

The current New Hampshire Unified Disadvantaged Business Enterprise (DBE) Directory is
available on the NHDOT website at http://www.nh.gov/dot/business/contractors.htm. If you have
questions or do not have access to the Internet, the directory may be obtained from DBE

Coordinator, located at 7 Hazen Drive, Concord, NH 03302, Tel: (603) 271-6612.

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7/29/2013
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SPECIAL ATTENTION

Disadvantaged Business Enterprise (DBE)

Disadvantaged Business Enterprise (DBE) Policy. It shall be the policy of the New Hampshire
Department of Transportation (NHDOT) to ensure nondiscriminatory opportunity for Disadvantaged
Business Enterprises (DBE’s) to participate in the performance of all contracts and subcontracts financed
with Federal funds as specified by the regulations of the United States Department of Transportation
(USDOT), Federal Highway Administration and as set forth below.

1. Policy. It is the policy of the United States Department of Transportation to ensure nondiscriminatory
opportunity for disadvantaged business enterprises, as defined in 49 Code of Federal Regulation (CFR)
Part 26, to participate in the performance of contracts and subcontracts financed in whole or in part with
Federal funds. Consequently, the DBE requirements of 49 CFR Part 26 applies to this contract.

2. Disadvantaged Business Enterprise (DBE) Obligation. The State and its Contractor agree to ensure

nondiscriminatory opportunity for disadvantaged business enterprises, as defined in 49 CFR Part 26, to
participate in the performance of contracts and subcontracts financed in whole or in part with Federal!
funds. Prime Contractors and subcontractors who further sublet must include this assurance in
every subcontract: The Contractor, sub recipient or subcontractor shall not discriminate on the basis of
race, color, national origin, or sex in the award and performance of this contract. The Contractor shall
carry oul applicable requirements of 49 CFR Part 26 in the award and administration of USDOT-
assisted contracts, Failure by any contractor to carry out these requirements is a material breach of this
contract, which may result in the termination of this Contract or such other remedy, as the NHDOT

deems appropriate.

3. Sanctions of Non-Compliance. The Contractor is hereby advised that failure of the Contractor, or
any Subcontractor performing work under this Contract, to carry out the requirements set forth in
paragraphs | and 2 above shall constitute a breach of contract and, after notification of the United States
Department of Transportation, may result in termination of this Contract or such remedy as the State

deems appropriate.

Overall Statewide DBE Goals. The NHDOT currently employs a race/gender neutral DBE policy to
attain its overall statewide DBE goals. This means that unless otherwise stated in the Contract, the
NHDOT relies on the voluntary cooperation of ail contractors to utilize DBE’s on every project, sufficient
to meet or exceed the current statewide DBE goal. Although the majority of statewide DBE goals are
currently voluntary, failure of the NHDOT to meet or exceed the overall statewide DBE goal as required
by the Federal Highway Administration (FHWA), could necessitate placement of mandatory DBE
participation requirements on all future statewide projects.

Disadvantaged Business Enterprise (DBE) Program Goals. The New Hampshire Department of
Transportation is required to set an overall DBE goal for participation in all transportation related
Federal-aid projects. The goal is determined following guidelines set forth in 49 CFR 26.45, and based on
the availability of ready, willing and able DBE’s who submitted bids for transportation related projects,
compared as a percentage of all available contractors who submitted bids for transportation related
projects during the same time period. The DBE goal may be adjusted to take into account other factors
impacting DBE utilization, in an effort to narrowly tailor the overall DBE goal. The detailed goal setting
methodology and current overall DBE goal may be viewed on the NHDOT website at www.oih gov/dot.

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7/29/2013
Page 2 of 4

Disadvantaged Business Enterprise (DBE) Definition. A DBE is defined as a business that is owned
and controlled by one or more socially and economically disadvantaged person(s). For the purpose of this
definition:

A. “Socially and economically disadvantaged person” means an individual who is a citizen or lawful
permanent resident of the United States and who is a Woman, Black, Hispanic, Portuguese, Native
American, Asian American, or a member of another group, or an individual found to be
disadvantaged by an individual determination of social disadvantage as described in 49 CFR 26
appendix E, determinations of social and economic disadvantage.

B, “Owned and controlled” means a business which is:
(1) A sole proprietorship legitimately owned and controlled by an individual who is a disadvantaged
person,
(2) A partnership, joint venture or limited liability Company in which at least 51% of the beneficial
ownership interests is legitimately held by a disadvantaged person(s).
(3) A corporation or other entity in which at least 51% of the voting interest and 51% of the
beneficial ownership interests are legitimately held by a disadvantaged person(s).

The disadvantaged group owner(s) or stockholder(s) must possess control over management, interest in
capital, and interest in earnings commensurate with the percentage of ownership. Disadvantaged
participation in a joint venture must also be based on the sharing of real economic interest and must
include proportionate control over management, capital, and earnings, as above. If the disadvantaged
group ownership interests are real, substantial and continuing and not created solely to meet the
requirements of this program, a firm is considered a bona fide DBE.

Certified DBE Directory. The current New Hampshire Unified Disadvantaged Business Enterprise
(DBE) Directory is available online at www.nh.gov/dot. This directory contains all currently certified
DBE’s available for work in New Hampshire, and is updated monthly. Only firm’s listed in this directory
are eligible for DBE credit on NH Federal-aid projects. If you have questions about DBE certification, or
do not have access to the Internet, please call the DBE Coordinator at (603) 271-6612 for assistance,

Counting DBE Participation For Project Goals. In order for payments made to DBE contractors to be
counted toward DBE goals, the DBE contractors must perform a commercially useful function (CUF).
The DBE must be responsible for execution of the work of the contract and must carry out its
responsibilities by actually performing, managing, and supervising the work involved, consistent with
standard industry practices. This means that:

A. The DBE must also be responsible for ordering its own materials and supplies, determining quantity
and quality, negotiating price, installing (where applicable) and paying for the material itself;

B, The DBE must perform work commensurate with the amount of its contract;

C. The DBE’s contribution cannot be that of an extra participant or a conduit through which funds are
passed in order to obtain the appearance of DBE participation;

D. The DBE must exercise responsibility for at least fifty percent of the total cost of its contract with its
own work force;

E. None of the DBE’s work can be subcontracted back to the Prime Contractor, nor can the DBE employ

the prime’s, or other subcontractor’s supervisors currently working on the project;

F. The DBE’s labor force must be separate and apart form that of the Prime Contractor or other
subcontractors on the project. Transferring crews between primes, subcontractors, and DBE
contractors is not acceptable;

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7/29/2013

Page 3 of 4

The DBE owner must hold a Public Works license and any other professional or craft licenses required

for the type of work he/she performs on the project;
The DBE may rent or lease, at competitive rates, equipment needed on the project from customary
leasing sources or from other subcontractors on the project.

Allowable credit for payments made to DBEs for work performed. A contractor may take
credit for payments made to a certified DBE that satisfies (CUF) requirements at the following

rate.

A.

B.

J.

A DBE Prime Contractor, count 100% of the value of work performed by own forces, equipment and
materials count towards DBE goals.
An approved DBE subcontractor; count 100% of the value of work performed by the DBE’s own
forces, equipment and materials, excluding the following:

e The cost of materials/supplies purchased from a non-DBE Prime Contractor.

e The value of work provided by non-DBE lower tier subcontractors, including non-

DBE trucking to deliver asphalt to a DBE contractor.

A DBE owner-operator of construction equipment; count 100% of expenditures committed.
A DBE manufacturer; count 100% of expenditures committed. The manufacturer must be a firm that
operates or maintains a factory or establishment: that produces on the premises the materials or
supplies obtained by the Prime Contractor,
A regular DBE dealer/supplier; count 60% of expenditures committed.
A regular dealer/supplier is defined as a firm that owns, operates, or maintains a store, warehouse or
other establishment, in which the materials or supplies required for the performance of the contract
are bought, kept in stock, and regularly sold or leased to the public in the usual course of business. A
person may be a dealer in such bulk items as petroleum products, steel, cement, gravel, stone or
asphalt without owning, operating or maintaining a place of business, if the person both owns and
operates distribution equipment for the products, by the means of a long term agreement, and not by a
contract by contract basis,
A DBE Broker; count for DBE credit only the fees or commissions charged for assistance in the
procurement, and, fees and transportation charges for the delivery of materials or supplies required at
the job site, but not the cost of materials procured. A broker is defined as any person(s) or firm who
arranges or expedites transactions for materials or supplies, and does not take physical possession of
the materials or supplies at their place of business for resale.
A DBE renter of construction equipment to a contractor; count 20% of expenditures committed, with
or without operator,
A bona fide DBE service provider; count 100% of reasonable fees or commissions.
Eligible services include professional, technical, consultant, or managerial, services and assistance in
the procurement of essential personnel, facilities, equipment, materials or supplies required for the
performance of the contract. Eligible services also include agencies providing bonding and insurance
specifically required for the performance of the contract.
A trucking, hauling or delivery operation, count 100% of payments when trucks are owned, operated,
licensed and insured by the DBE and used on the contract and, if applicable, includes the cost of the
materials and supplies. 100% of payments when the DBE leases trucks from another DBE firm
including an owner-operator. 100% of reasonable fees, or commissions, the DBE receives as a result
of a lease arrangement for trucks from a non-DBE, including an owner-operator,
Any combination of the above.

Reporting Requirements for Payments Made To DBE’s: On all Federal-aid projects, the Prime
Contractor is required to report payments made to DBE’s during the life of the contract, on a quarterly
basis, for the periods covering January Ist~March 31st, Apri! Ist-June 30th, July Ist-September 30th and
October Ist-December 31st, The NHDOT will provide the Prime Contractor with a quarterly DBE

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Page 4 of 4

payments report, detailing all DBE’s subcontracted by the Prime Contractor, per project. The Prime
Contractor shall report any payments made to DBE’s during the requested reporting period. This
documentation shall be submitted to the Office of Federal Compliance within the time period stated on
the NHDOT quarterly request. Failure of the Prime Contractor to submit this information may result in
the Department withholding progress payments.

Removal of Approved DBE From Transportation Related Project: Contractors may not terminate for
convenience, any approved DBE subcontractor and perform the work with their own forces, without prior
written consent from the NHDOT,

MUNICIPAL PROJECTS ONLY: Timely submission of invoices to Municipalities: Prime
Contractors must submit all invoices received for satisfactorily completed work, from any
subcontractor/lower-tier subcontractor/material supplier, to Municipalities for payment within 30
days of receipt.

SA

Rev, 6/2/10
Supersedes Spec, Attn. dated 3/9/90, 12/5/90, 4/4/92, 2/22/93, 4/24/95 & 6/5/98

ALL FA PROJECTS (STEEL & IRON PRODUCTS)

SPECIAL ATTENTION
BUY AMERICA

In accordance with the BUY AMERICA requirements of the Federal regulations, all
manufacturing processes for steel and iron materials furnished for permanent incorporation into
the work on this project shall occur in the United States. The only exception to this requirement
is the production of pig iron and the processing, pelletizing and reduction of iron ore, which may
occur in another country. Other than these exceptions, all melting, rolling, extruding, machining,
bending, grinding, drilling, coating, etc. must occur in the United States.

Products of steel include, but are not limited to, such products as structural steel, piles,
reinforcing steel, structural plate, steel culverts, guardrail and steel supports for signs, signals and
luminaires. Products of iron include, but are not limited to, such products as cast iron frames and
grates, Coatings include, but are not limited to, the applications of epoxy, galvanizing and paint.
The coating material is not subject to this clause, only the application process.

A Certificate of Compliance, conforming to the requirements of Section 106.04, shall be
furnished for steel and iron materials. Records to be maintained by the contractor for this
certification shall include a signed mill test report and a signed certification by each supplier,
distributor, fabricator, and manufacturer that has handled the steel or iron product affirming that
every process, including the application of a coating, performed on the steel or iron product has
been carried out in the United States of America, except as allowed by this Special Attention.
The lack of these certifications will be justification for rejection of the steel or iron product.

The requirements of said law and regulations do not prevent a minimal use of foreign steel
and iron materials if the cost of such materials used does not exceed one-tenth of one percent
(0.1%) of the total contract price or $2,500.00, whichever is greater.

Upon completion of the project, the Contractor shall certify in writing as to compliance
with this Special Attention and also provide the total project delivered cost of all foreign steel
and/or iron permanently incorporated into the project. The form for this certification is entitled
“Buy America Certificate of Compliance” and can be found at www.NHDOT.com.

\hendotfilel\global\specifications\sa spec attn\buy america iron.doc

SA

December 24, 1998
Supersedes Spec. Attn. dated 3/29/88 & 12/5/90

FHWA Projects

SPECIAL ATTENTION

CONTRACT AFFIDAVIT - CERTIFICATION REGARDING DEBARMENT
SUSPENSION

The separate form entitled, CONTRACT AFFIDAVIT (As Required by Section 112(c) of
Title 23 USC) has been deleted from this proposal.
Bidders are advised that the last page of the bidding proposal has been revised to include the

same reference, IN BOLD PRINT, relative to the non-collusion statement included on the

discontinued form.

XXXXXXXXKXXKXXXX

The Contractor is advised that 49 CFR 29.510, Appendix A, requires that the Contractor,
including all principals, certify that they are not currently under debarment or suspension or have not
been under debarment or suspension within the past three years. (For certification instructions see next
page).

The certification has been added, IN BOLD PRINT, onto the next to the last page of the
bidding proposal.

The Contractor is further advised that Appendix B of 49 CFR 29.510 regarding certification of

lower tier transactions has been added to Form FHWA-1273.

SASPECSISPECA TT MCONT -AFF DOC

December 24, 1998 SA
Supersedes Spec. Attn. dated 12/5/90

Appendix A - Certification regarding Debarment, Suspension, and other Responsibility Matters - Primary Covered
Transactions.

Instruction for Certification

1, By signing and submitting this proposal. the prospective primary participant is providing the certification
set out below,

2. The inability of a person to provide the certification required below will not necessarily result in denial of
participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot
provide the certification set out below, ‘The certification or explanation will be considered in connection with the
department or agency’s determination whether to enter into this transaction. However, failure of the prospective
primary participant to furnish a certification or an explanation shall disqualify such person from participation in this
transaction.

3, The certification in this clause is a material representation of fact upon which reliance was placed when the
department or agency determined to enter into this transaction, If it is later determined that the prospective primary
participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal
Government, the department or agency may terminate this transaction for cause of default,

4, The prospective primary participant shall provide immediate written notice to the department or agency to
whom this proposal is submitted if at any time the prospective primary participant learns thal its certification was
erroncous when submitted or has become erroneous by reason of changed circumstances.

5. The terms "covered transaction,” “debarred,” “suspended,” “ineligible,” “lower tier covered transaction,”
“participant,” “person,” “primary covered transaction,” “principal,” “proposal,” and “voluntarily excluded,” as used in
this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive
Order 12549. You may contact the depariment or agency to which this proposal is being submitted for assistance in
obtaining a copy of these regulations.

6. The prospective primary participant agrees by submitting this proposal that, should the proposed covered
\ransaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is
debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless
authorized by the department or agency entering into this transaction

7. The prospective primary participant further agrees by submitting this proposal that it will include the clause
titled “Certification” Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered
Transaction,” provided by the department or agency entering into this covered transaction, without modification, in all
lower Her covered transactions and in all solicitations for lower tier covered transactions,

8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower
ticr covered transaction that is not debarred, suspended, incligible, or voluntarily excluded from the covered
lransaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by
which it determines the eligibility of its principals. Each participant may, but is not required to, check the
Nonprocurement List.

9. Nothing contained in the foregoing shall be construcd to require establishment of a system of records in
order to render in good faith the certification required by this clause. The knowledge and information of a participant is
not required to exceed that which is normally possessed by a prudent person in the ordinary course of business
dealings.

30, Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered
iransaction knowingly enters into a lower Lier covered transaction with a person who is suspended, debarred, incligible,
or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal
Government, the department or agency may terminatc this transaction for cause or default,

SASPECSS PECA TT MWDEBAR-IN.DOC

SA
1/2001

Supersedes 3/90
ALL FA PROJECTS

SPECIAL ATTENTION
LOBBYING

UNITED STATES DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION

SUBJECT: LIMITATION ON USE OF GRANT OR CONTRACT FUNDS FOR LOBBYING

The lobbying restrictions were established by Section 319 of Public Law 101-121 (Department
of the Interior and Related Agencies Appropriations Act for Fiscal Year 1990).

The law prohibits Federal funds from being expended by the recipient or any lower tier
subrecipients of a Federal contract, grant, loan, or cooperative agreement to pay any person for
influencing or attempting to influence a Federal agency or Congress in connection with the awarding of
any Federal contract, the making of any Federal grant or loan, or the entering into of any cooperative
agreement. The extension, continuation, renewal, amendment or modification of any Federal contract,
grant, loan, or cooperative agreement is also covered.

Federal-aid contractors, and consultants, as well as lower tier subcontractors and
subconsultants are also subject to he lobbying prohibition. To assure compliance, a certification
provision is included in all Federataid construction solicitations and contracts, and consultant
agreements exceeding $100,000 in Federal funds.

The Contractor shall be aware that by signing and submitting this proposal, he or she is attesting
to the requirements of the certification provisions.

During the period of performance of a grant or contract, recipients and subrecipients must file
disclosure form (Standard Form LLL) at the end of each calendar year quarter in which there occurs
any event that requires disclosure or that materially affects the accuracy of the information contained in

any previously filed disclosure form.

Lower tier certifications should be maintained by the next tier above (i.e., prime contractors will
keep the subcontractors’ certification on file, etc.}. Copies of Standard Form LLL will be included in
the subcontract package for distribution to successful bidders.

S:ASPECS\SPECATTMLOBBYING DOC