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An Individual

Name (typed or printed):

By: (SEAL)
(individual's Signature)
Doing business as:

Business address:

Phone No.: Fax No.:

A Partnership

Partnership Name: (SEAL)

Date and State of Organization

Names of Current General Partners

Name Title

Type of Partnership
[] General [] Publicly Traded
[] Limited [[) Other (describe):

By:

(Signature of General Partner ~ attach evidence of authority to sign)

Name (typed or printed):

Business address:

Phone No.: Fax No.:

BF 4 of 8

FITZEMEYER ,
&TOCCIE"® Project Approach

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pax TEAM ORGANIZATION

Principal in Charge —- Thomas Tsaros

* The officer-in-charge will serve as the overall supervisor of the project team, ensuring the incorporation of
all client requirements, direct and review all project deliverables and coordinate and monitor all design and
construction activities. The officer-in-charge is responsible for client satisfaction and will be in direct contact
with the owner during the entire duration of the project.

Energy & Infrastructure Service Leader — Nathaniel Fanning

* The commissioning engineering department manager is responsible for the daily execution of the
commissioning process by the commissioning team. This team members serves as the direct liaison between
the commissioning engineering team and the owner, design and construction teams. The department manager

ensures that project commissioning resource needs are met and that the quality of service proposed by the firm
is delivered upon.

Commissioning Engineer — Patrick Huston

* The commissioning engineer will be responsible for the development of commissioning documentation,
execution of functional testing and associated field work. The commissioning engineer works in close
coordination with the commissioning department manager to plan and schedule work and with the principal-

in-charge to ensure all aspects of project scope and contractual obligations are executed to the satisfaction of
the client.

Er PROPOSED SCHEDULING

- Anticipated engagement of the commissioning team - 04/2022
« Anticipated start of design phase — 04/2022
- Development of commissioning specification and design reviews
« Anticipated start of construction phase — 04/2022
- Progress meetings and periodic site visits to monitor construction and review start-up activities
- Functional testing will be conducted subsequent to the conclusion of testing and balancing and
point-to-point checkout
« Anticipated project completion — 02/2023
- A final report will be developed and submitted after the closeout of non-conformance log items.
«+ Anticipated warranty (post-commissioning) phase completion — 02/2024
- Perform trend and data reviews as requested

dl,
Aah ENGINEERING AND COMMISSIONING SERVICE EXECUTION

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Commissioning service execution is efficiently integrated into the construction process when there is buy-in
established by all parties early in the development of the project. Buy-in should not be forced, rather established by
the commissioning team communicating that the objective of commissioning is not to solely find issues during the
construction process, but rather to demonstrate the successful execution of work by design and construction team
members. When work is not completed properly or successfully our team’s role is to first identify these items, but
more importantly we must serve as an active member in formulating and executing remedial action.

MECHANICAL | ELECTRICAL | IT | COMMISSIONING ENGINEERS

A Corporation
Corporation Name: _Kenyon Pipeline Inspection, LLC (SEAL)

Date and State of Incorporation: _ 9/14/2011 New York State

List of Executive Officers

Name Title
Jason R. Kenyon CEO
Joshua R. Kenyon President

a ye a Liability): Limited Liability

\ (Signature -- attach evidence of authority to sign)

Name (typed or printed): _ Jason R. Kenyon
Title: CEO 7) (Corporate Seal)

Attest: CBG CC —
/

Ciknature of Corporate Secretary)

Business Address: 68 Park Road Queensbury, NY 12804

Phone No.: 518-832-4070 Fax No.: 518-348-3040

Date of Qualification to do business is__ 9/14/2011

A Joint Venture

Joint Venture Name: (SEAL)

Date and State of Organization:

Name, Address and Form of Organization of Joint Venture Partners: (Indicate managing partner

by an asterisk *)

BF 5 of 8

By:

(Signature of joint ventured partner -- attach evidence of authority to sign)

Name (typed or printed):

Title:

Business Address:

Phone No.: Fax No.:

Address for receipt of official communications:
68 Park Road

Queensbury, NY 12804

(Each joint ventured must sign. The manner of signing for each individual, partnership and
corporation that is a party to the joint venture should be in the manner indicated above).

BF 6 of 8

LIST OF SUBCONTRACTORS
(to be submitted with bid)

The name and address of each subcontractor who will be paid at least five percent (5%) of the prime
contractor's total bid shall be listed below. To be deemed a responsive bid, this form must be submitted
even if no subcontractors are required to be listed. In that case, the bidder should state “None” (or similar
language stating that no subcontractors need to be listed) in the space below. (Refer to General Condition
6.09.H)

Name Address of Subcontractor Portion of Work
Simoneau Excavating 4 Homestead Lane Hudson, NH Excavation 20%

BF 7 of 8

LIST OF SUBCONTRACTORS
(to be submitted after bid opening)

Within one (1) day after the completion of the opening of the bids, the general contractors who
submitted the three lowest bids must provide a list of each subcontractor who will provide labor or a
portion of the work or improvement to the contractor for which the subcontractor will be paid an amount
exceeding one percent (1%) of the prime contractor's bid or $50,000, whichever is greater, and the
number of the license issued to the subcontractor. If a general contractor fails to submit such a list
within the required time, the bid shall be deemed not responsive. To be deemed a responsive bid, this
form must be submitted even if no subcontractors are required to be listed. In that case, the bidder should
state “None” (or similar language stating that no subcontractors need to be listed) in the space below.
(Refer to General Condition 6.09.H.)

Dollar Value and
Subcontractor/Address description of work
Simoneau Excavation LLC 4 Homestead Lane Hudson, NH $580000.00

BF 8 of 8

BID BOND
PENAL SUM FORM

BIDDER (Naine and Address):
Kenyon Pipeline Inspection, LLC
68 Park Road
Queensbury, NY_ 12804

.ETY (Name-and Address of Principal Place of Business):
United States Fire Insurance Company
305 Madison Avenue

Morristown, NJ_ 07960

OWNER (Name and Address):
City of Nashua
__229 Main Street

Nashua, NH_ 03061

BID
BID DUE DATE: February 12, 2019
PROJECT (Brief Description Including Location);
2019 CIPP Lining Project
1FB1087-021219

BOND
BOND NUMBER: NA
DATE: (Not later than Bid Due Date): February 12, 2019
PENAL SUM: Five Percent of Amount of Bid _ $---5%---
(Words) (Figures)

IN WITNESS WHEREOF, Surety and Bidder, Intending to be legally bound hiereby,. subject to the terms

Printed oh the reverse side hereof, do each cavise the Bid Bond to be duly-executed. on its behalf by its
authorized officer, agent, or representative.

BIDDER SURETY
Kenyon Pipeline Inspection, LLC (Seal) United States Fire Insu
idder's Name and Corporate Seal rs Hig-anid Corporate S
;
Bys Yo By: Oum_t. {
G ~~ — SFpatureand Title Dawn J. Riley Signatiiré- aiid Title\Attorney-in-Fact

(Attach Power of Atteraty)

Attest: _ See Power of Attorney

. Li 7
Sinan sand Lille Signature and Title
ki ' ” “ft Jr eer MManagour

Note: (1) Aboveaddresses -areta be used for giving required notice. -— a
(2) Any sidgillar reference to Bidder, Surety, OWNER or other party shall be considered plural where applicable:

Attest:

BB -1 of 2

L.

Bidder and Surety, jointly and severally, bind
themselves, their heirs, executors, administrators,
successors, and assigns to. pay to OWNER upon
default of Bidder the penal sum set forth on the face
of this Bond.

Default of Bidder shall occur upon the failure of
Bidder to deliver within the time required by thé
Bidding Rocuments (or any extension thereof
agreed toin writing by OWNER) the executed
Agreement required by the Bidding Documents and.
any performance and payment bonds required by
the Bidding Documents and Contract Documents.

This obligation shall be null and void if:

3.1, OWNER accepts Bidder’s bid and Bidder
delivers within ithé tinie required by the
Bidding Docunients (or any exterision thereof
agreed to in writing. by’ OWNER) the executed
Agreement required. by the Bidding Docuntents
and any performance and payment bonds
required by the Bidding Documents and
Contract Documents, or

3.2 All Bids are rejected by OWNER, or

3.3. OWNER fails to isstie a notice of award to
Bidder within the time specified in the. Bidding
Documents (or yexténision thereof agreed to
in writing. by Bic der and, if applicable,
consented to by- ‘Surety when required by
paragraph § hereof):

Payment under this:bond will be due and payable
upon default by Bidder and Within 30 calendar
days after receipt by Biddeér-and Surety of written
nance of default from: OWNER, which notice. will
be-given with reasonable ‘promptiess, identifying
this Bond and the Pidject'and includitig a statement
ofthe amount due.

Surely waives notice‘of and any and all defenses
based on or arising'out of’ ‘any time extension to
issué notice of award agreed to in writing by
OWNER and Bidder, provided that the time for
issiliAg Notice. of Award including extensions shall
notin the aggregate exceed 120 days from Bid Due
Date without Surety’s, Written consent.

No sujt‘or action shall‘be commenced under this
Bond prior to 30 valend a ‘days after the notice of

default:tequired in paragraph 4 above is received by

Bidder and Surety, and in:no case'later than one
year after Bid-due date.

7. Any suit or action under this Bond shall be
commenced; only i in‘a court of competent
jurisdiction located in the state in which the Project
‘is located.

8. Notice required hereunder shall be in writing and
Sent. to Bidder arid:Suréty at their respective
addresses stiown.6r-the facé of this Bond. Such

ridfices.may be seit b ersonal delivery,

pre-paid, and'shal I be fee to be effective upon
receipt by the party:concetned.

9. Surety shall causeto be'attached to this Bond a
current and effective Power of Attorney evidencing
the authority of the officer, agent or representative
who-execufed this 'Bond-on behalf of Surety to
exécute, seal atid deliver'such Bond and bind the
Surety thereby.

10, This Bond is iitended ta Conform to all applicable
Statutory requirements, y applicable requirement
of any. applicabie: ‘Statute t hat ‘has heen omitted from
this:Bond shal] bedeeined to be included herein 2g
if'set forth atlength.Jf any provision of the Bond
conflicts with any, applicable provision of any
applicable statute; ‘then the provision of said statute
Shall govern:and the remainder of this Bond that is
notin conflict therewith shall continue in full force
‘Gnd effect.

1}, The-term “Bid” as used herein includes a Bid, offer
‘Of proposal as applicable,

BB - 20f 2

individual Acknowledgement

State of
County of

On this day of , 20 , before me personally came

to me known and known to me to be the individual(s) who executed the foregoing instrument, and
acknowledged that___he____ executed same.

Notary Public
My commission expires

Limited Liability Company/Partnership Acknowledgement

State of New York

County of Warren

On this 12th day of ___ February , 20 __19 _, before me personally
came JOU] R Kendor a member, manager or general

partner of___Kenyon Pipeline Inspection, LLC
to me known and known to me to be the person who is described in and who executed the foregoing
instrument and acknowledges to me that he executed the same.

Notary Public
My commission expires .

ALANA HUTCHINSON
Notary Public, State of New York
Reg. No. 01HU6365707
Qualified In Warren County
Commission Expires Oct. 16, 2021

Corporate Acknowledgement

State of
County of

On this day of , 20 __, before me personally came to
me known, who being by me duly sworn, did depose and say that he resides in

that he is the of the the corporation described in
and which executed the foregoing instrument, and that he signed his name thereto by order of the Board
of Directors of said corporation.

Notary Public
My commission expires
Surety Acknowledgement

State of New York

County of Albany

On this 12th day of _February ,20_19 __, before me personally came _Dawn J. Riley

to me known, who being by me duly sworn, did depose and say that he/she resides in
Albany, New York that he/she is the Attorney-in-Fact of the

United States Fire Insurance Company __, the corporation described in and which executed the foregoing
instrument; that he/she knows the Seal of said corporation; that one of the Seals affixed to the foregoing
instrument is such Seal; that it was so affixed by order of the Board of Directors of said corporation; and

that he/she signed his/her name thereto by like order. } O..
CARLEEN ANN LEGAULT VOC» 4, LQ of Q)
Novaiy Foo ease” ae Notary Pub
No. O1L we .
Qualified in Albany County 4] y commission expires 4 [
Commission Expires Jan. 26, 20_=

UNITED STATES FIRE INSURANCE COMPANY
1209 ORANGE STREET, WILMINGTON, DELAWARE 19801

STATEMENT OF ASSETS, LIABILITIES, SURPLUS AND OTHER FUNDS

AT DECEMBER 3], 2017
ASSETS
Bonds (Amortized Valut).....4.s-sseesscescecctecctesnas lnobeacSete cts oqeinasTSastontsecsencdiecasieesocsncsersesevecse 852,724,517
Preferred Stocks (Market Value).............c00c00ee. ec reeeces peenbegensngecasecscestesasobercanscesaeseorescnsenseseneens 2,500,000
Common Stocks (Market Value)......ccccescessscsersesecsucssteusensoeacecscrcceedesctnoesicacensecetovscrececceesseceses 1,278,534,869
Cash, Cash Equivalents, and Short Term Investments... . 1,110,717,497
Derivatives ci.c3..cseseceeesecccceeascersesecaeersenee cap enes 11,462,474
Other Invested ASSets,,...-cccccpsseserenseres cc caeceeeee vee 335,759,125
Investment Income Due and Accrucd....,.....1....sseresapseeveuecavansoncecceus sacusessccnescaccusecaeconscnecenceaeaes 8,013,891
Premiums and Considerations............. apesee LacesbgceecdSesesdbecdiaecronacesscencsneces 237,021,943
Amounts Recoverable from Reinsurers......sccseseseoos: : 23,944,019
Funds Held by or Deposited with Reinsured Companies.....s:csseseccosssancsenses vadSSbaccatleretevccnsserscnssenecten 4,521,882
Current Income Taxes Recoverable............:s:sscscoecesscserosseccctusneesecnessvecsseestscceenceceteasscseesse 324,900
Net Deferred Tax ASS€L.....-ccsecsccoessceecones 435,312,662
Electronic Data Processing Equipment...... 3,772,271
Receivables from Parent, Subsidiaries and Affiliates 26,323,495

Other ASSts.....-ccscecccecccncessesceedteecderessecnenscaeseaeenae aeons wee 63,413,033
TOTAL ASSETS........ desees tesees obec erseeeereerseenrewesersoesssesnessetensenceeneee A eoeecavennonen 4.094,.346,578

LIABILITIES, SURPLUS & OTHER FUNDS

Losses (Reported Losses Net of Reinsurance Ceded and Incurred

But Not Reported Losses)........ Geeeeescseseseeeesasss Eavddalsidunesecccee sss scdecsedensverscerbosscecsessoussenecnsces 1,570,075,192
Reinsurance Payable on Paid Losses and Loss Adjustment Expenses.. 4Y...¢ 76,325,088
Loss Adjustment Expenses......... tee neeeecaeepeaes cneetees cearaenceonees 394,866,509
Commissions Payable, Contingent Commissions and Other Similar Charges. . 6,115,178
Other Expenses (Excluding Taxes, Licenses and Fees)... sees seccereeessenesecsdeeeasrasesesteaststersenecescsecse 53,552,681
Taxes, Licenses and Fees (Excluding Federal Income TeX05). ccs Berson susan ss tnccnate, 20,497,732
Uneamed Premiums......sc0-s0s0005 tice eeteeneee en satees 504,835,046
Advance Premium...........ccccccsesectecessenseceseesseseesscen bet etgeegen eee peeseee eeeees 3,459,204
Ceded Reinsurance Premiums Payable........ iesek eee enaeeeeeeneceeeereeses sees fae 23,031,797
Funds Held by Company under Reinsurance Treaties... 16,414,772
Amounts Withheld by Company for Account of Others.. aed 68,163,429
Provision for Reinsurance... ceesesecsen ey OE Be ee Beak ae 900,479
Payable to Parent, Subsidiaries ‘and Affiliates... deveoaeaeneesseseastecstaseseeremsensesssenssssconctetacrcecsanedtee 21,048,714
Other Liabilities ........... 00.0008 MeteabeS Sd aecceSiaaccncneccaace ae -WUescv oases csbsatttonsserseessccsans Prk 32,798,898

TOTAL LIABILITIES . oscar beuteeccnsseaesee enced sesge see csucse crt eseeenenesnens es cteaetenecetesnces $2,792,084,719
Common Capital Stock.. beneee cee ee ec ee eas avenss cesses ces sasepCaneenepesmomsna nie bederersecstoscnscses 12,210,000
Gross Paid In and Contributed Surplus... OPTS BUND oo 2e Tee edb cnc eccee ofa odo ennistha bROOEIEsSesbvncsLiVaiheS daseee 1,115,644,940
Unassigned Funds (Surplus).........-..ccsescesesesesteseeeeeces aeeeene pee veeeeence dreeeecee deewcerrecvceenssevesceesensere 174,406,919

Surplus as Regards Policyholdess............sscccseereenere tees a oa 1,302,261,859

TOTAL LIABILTIES, SURPLUS & OTHER FUNDS. tesresearvesceeucerecsecnsesreceerenracss $4,094,346,578

I, Carmine Scaglione, Vice President and Controlter of UNITED STATES FIRE INSURANCE COMPANY, certify that the foregoing is a fair statement of Assets,
Liabilities, Surplus and Other Funds of this Company, at the close of business, December 31, 2017, as reflected by its books and records and as reported in its statement
on file with the Insurance Department of the State of Delaware.

Fa

——

a “N-TRSTIMONY WHEREOF, I have set my hand and affixed the seal of the Company, this 6th day of March, 2018,
" WNTED ST ATES FIRE INSURANCE COMPANY

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